Recovery Services Questionnaire
Frequently Asked Questions
Table of Contents
- Who is Meridian? Why do I have to fill this
out?
- Is what Meridian is doing legitimate?
- Do I have to respond to the questionnaire even
if my treatment is not related to any accident?
- Why are you sending me a questionnaire on non-accident related treatments or tests?
- What is a diagnosis code?
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What should I do if I cannot remember what happened on the date of service you provided?
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Why can’t I find out what service my spouse or child (over the age of 18) was seen for? I am the policyholder.
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If you are following privacy laws, then why are you asking me for personal information, including my date of birth?
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I filled out a form like this with my doctor and my insurance company. Why are you sending me another questionnaire?
- Why are you asking me about a date of service that happened over a year ago?
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I answered this once for you, why are you sending me another one?
- How can I stop getting these questionnaires?
- Who is this provider? I never saw a doctor or went to this clinic/hospital?
- Have my medical bills been paid?
- Is Meridian selling insurance?
Who is Meridian? Why do I have to fill out this questionnaire?
Answer
- Meridian Resource Company is a national cost containment company that specializes in third party liability and workers’ compensation recoveries. Meridian is a subsidiary of WellPoint, Inc. a leading company in the healthcare benefits industry. Meridian is contracted by your health plan to provide subrogation services, including claim investigations. We work on behalf of your health plan to recover money for the plan for any medical claims that were paid due to accidental injuries where another party may be responsible for payment, such as an auto insurance policy or workers’ compensation. This process helps to reduce the amount of claims dollars that your insurance plan pays, and in turn what the plan charges you for premiums.
Is what Meridian is doing legitimate?
Answer
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Yes. Meridian has a business agreement with your health plan that is compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that allows Meridian to access your protected health information and send questionnaires as part of the claims process. We have been contracted by your health insurance plan to pursue subrogation recovery on their behalf. Meridian complies with all state and federal laws that govern subrogation recoveries.
Do I have to respond to the questionnaire even if my treatment is not related to any accident? the questionnaire even if my treatment is not related to any accident?
Answer
-Yes. As this is part of your health insurance plan, Meridian will continue to send questionnaires on behalf of the plan to get a response. Responding to the questionnaire is required by your health plan, as they have the right to investigate claims to properly determine payment. If you have any further questions about this, you may refer to your plan documents or summary of benefits regarding “Subrogation” or “Rights of Recovery.” The sending of questionnaires is an automatic process, and is stopped once a response is received from you.
Why are you sending me a questionnaire on non-accident related treatments or tests?
Answer- Meridian uses trauma related diagnosis codes that are most commonly related to workers’ compensation or third party injuries to identify claims for review. Some types of claims that would fall under this category include, but are not limited to: ER visits, ambulance services, radiological services, pain management care, chiropractic care, and physical therapy. While many times the services are for ongoing medical conditions, these could also be a result of a trauma related incident.
What is a diagnosis code?
Answer - Your provider assigns a diagnosis code to all claims that are submitted for payment. This code is part of the International Classification of Diseases set forth by the World Health Organization. This classification allows providers the ability to use a universal numeric language when treating a condition, that is recognized by fellow providers and health plans. Some codes may be for a general condition like backache, or for a more specific condition like a fracture of the femur etc. While the diagnosis code is applied, the reason for the diagnosis code (like car accident or injury at work) is often not provided.
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What should I do if I cannot remember what happened on the date of service you provided?
Answer - If you cannot recall or have questions about the service that was provided on the date shown on the questionnaire, please contact our Customer Care Center at 1-800-645-9785 and one of our customer care associates will be happy to assist you. You will be asked for your reference number shown on the questionnaire, along with your date of birth and the date of service. Please keep in mind that if the patient is over the age of 18, we cannot provide this information to anyone other than the patient due to HIPAA privacy laws.
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Why can’t I find out what service my spouse or child (over the age of 18) was seen for? I am the policyholder.
Answer -
HIPAA privacy laws are very strict about the release of protected health information. This federal law prohibits us from releasing personal health information to anyone other than the patient, if they are over the age of 18; even if the policyholder is a spouse or parent. Should the patient provide the proper consent, Meridian will gladly talk to an authorized party on the patient’s behalf. While we understand that this can be frustrating, these measures are in place to protect your privacy, and theirs.
If you are following privacy laws, then why are you asking me for personal information, including my date of birth?
Answer - These privacy laws require us to identify the caller prior to releasing protected health information. These measures prevent the release of your protected health information to unauthorized parties. The date of birth is one of the steps we use to validate your identity.
I filled out a form like this with my doctor and my insurance company. Why are you sending me another questionnaire?
Answer - Per HIPAA regulations, Meridian receives the minimum necessary information to complete our job. While you may have provided similar information to your doctor or your insurance company, the information that Meridian requires is somewhat different and assists us with pursuing the responsible parties for reimbursement of medical bills paid on your behalf.
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Why are you asking me about a date of service that happened over a year ago?
Answer - Sometimes when Meridian starts working with your health plan, they may not have used a subrogation company in the past, and request us to go back a reasonable amount of time to check previous claims, sometimes up to a year. It might also take several months for claims to be received and paid by your health plan. Other factors that might contribute to the age of the date of service would be a change in your address or if your claim was previously denied, and now adjusted for payment.
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I answered this once for you, why are you sending me another one?
Answer - If you recently returned a questionnaire, it may be that your response crossed in the mail. Meridian produces 2nd and 3rd request questionnaires automatically at 30-day intervals. If you responded some time ago, but continued treatment, it is possible that a new questionnaire was produced as a result of those additional treatments. Other factors that might contribute would be a change in identification number or employer change; you would be recognized as a new member. Meridian does its best to avoid sending duplicate questionnaires and have systems in place to address this as best we can. If you receive a questionnaire and believe that you have already responded to it, please call our Customer Care Center or 1-800-645-9785 to verify with a representative that we have in fact received your response.
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How can I stop getting these questionnaires?
Answer - Once Meridian receives a response from you, the questionnaire is closed out. However, should your treatment continue for six months or if you sustain any new injuries another questionnaire will be sent to you to verify that the new or continuing treatment is not related to a new workers’ compensation or other third party injury. You have three options when responding. You may complete the online form 24 hours a day, 7 days a week; you may complete the form and mail it back to us in the envelope provided, or you may call our Customer Care Center from 7:30am to 7:00pm CST.
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Who is this provider? I never saw a doctor or went to this clinic/hospital?
Answer - Often when you have a radiological service such as an MRI or an X-ray, the results may be interpreted by a doctor different that your treating physician. This is very common, and in most cases you will not be given that doctor’s name. There are also times when your provider is part of a larger group or billing company and you may not recognize the name. This especially occurs with ER Physicians and various Independent Physician Associations. If you have any questions regarding the provider, your may contact your health plan using the number listed on your identification card.
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Have my medical bills been paid?
Answer - Meridian only sends questionnaires on bills that have been paid by your health plan. There may be instances though in which a bill was paid, but then later adjusted to reverse the payment. In general, the date of service on the questionnaire has been paid according to your benefits. Meridian cannot verify or guarantee payment of any medical bills by the plan. If you are concerned with the status of a claim, or payment issue, you must contact your health plan by using the phone number for customer inquiries found on the back of your health insurance card.
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Is Meridian selling insurance?
Answer - Meridian is not in the business of selling insurance or soliciting the sale of insurance in any way. We do however work in conjunction with your health insurance plan to complete the claims process by reviewing claims that may be work or accident related.
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