The Claim That Came Back

Abstract

A denied claim is usually born at the first desk, weeks before it comes back. It is a quarter past seven on a Wednesday, and the billing coordinator of a family medicine practice is at her desk before the first patients arrive. The practice has eight doctors and serves a mixed neighbourhood: families with employer insurance, older patients on Medicare, a good number on Medicaid. Her screen shows the week's denials, claims the insurers have sent back unpaid. There are a hundred and forty of them. She has time, realistically, to work about sixty before Friday. The first one is ordinary. A woman was seen in January for a chest infection, and the claim was sent to the insurer on her file. The insurer has replied that her coverage ended on the thirty-first of December. She changed jobs over the holidays. Her new card was in her purse the whole time. Nobody at the front desk asked to see it, because she had been a patient for six years and her details were on the system.