Practice Management Alert

Question: We recently dismissed a patient by sending her a certified letter and informing her she had 30 days to find a new doctor. The patient then contacted her insurance company. The insurance company's provider rep called us and started questioning why we did not notify them about the dismissal. Does the insurance company have a need to know about patient dismissals?

South Carolina Reader

Answer: If the physician is a primary care provider, such as a pediatrician, the payer may have a physician assigned to the patient in their records. The payer might require that the patient has a physician listed as his primary care provider in order to receive proper coverage and payment as well as managed care.

Therefore, ending the provider-patient relationship removes the physician from the patient's insurance record.

You may benefit from reviewing your contract with that particular payer and see if the contract addresses that situation.

Many contracts require notification or additional communication when a patient's assigned primary care provider is affected.