On some rare occasions, insurance companies will send a reimbursement check to the practitioner, rather than their member. There are a few reasons for this, with the most common being an error on the part of the insurance company. Reimbursify specifically files all claims as "paid in full to the practitioner" and directs reimbursement be sent to the client/patient directly. Occasionally, insurance companies simply ignore or incorrectly process a claim and the check is mistakenly sent to the practitioner. In these cases, we recommend you contact your insurance company and tell them "My practitioner uses software to file claims as a courtesy, even though I’ve paid them in full for their services. All of my reimbursements should come to me and not the practitioner."
There are a few other reasons why your insurance company might have sent reimbursement directly to your practitioner:
Your insurance company may use a third party administrator to process their claims. This is common with Collective Bargaining Agreements, where your insurance is provided through a large national insurance companies like Blue Cross or Cigna, but payment is actually handled directly through your union benefit office. In some of these cases, the insurance company only forwards over a limited amount of information regarding your claim, and this doesn't always include the details to reimburse the client/patient and not the practitioner.
- If your are a member of a union (or a similar collective bargaining group), you should contact your union benefits administrator to resolve this issue.
Another reason that reimbursement may be sent directly to your practitioner is that your practitioner is registered as "in-network" with that insurance company. This happens sometimes even in a completely out-of-network practice, because the practitioner was at one time in-network with the insurance company, and did not effectively sever that relationship when leaving their prior practice.
- If your practitioner was previously in-network with your insurance company, they will have to contact your insurance company directly in order to validate their change of status with them.
One other reason that we have seen (much less frequently) is that your insurance company plan dictates that reimbursement for out-of-network claims be sent to the practitioner, regardless of how the claim is filed.
- If your insurance plan dictates that all reimbursements for out-of-network care must be sent to your practitioner, you should discuss an alternate payment structure with your practitioner, so that they don't get paid twice (by you and by your insurance company) for the same service.