Wiki Billing Insurance without Release of Information

[jcochran]

So,
I have an interesting dilemma.

I work for a non-profit organization that treats private pay clients on a sliding fee scale basis. It is our policy that all clients seen on sliding fee scale must present their insurance information if and when they acquire it. We usually have client's fill out an authorization to bill insurance when the client's begin care.

I came across insurance on a client today who has insurance beginning 1/1/11. The insurance authorization I had was from 6/12/10 to 6/12/11. Is it ok for me to bill his insurance using the authorization as his visits we before 6/12/11? My boss is stating that we don't need the authorization to bill, but I don't want to do anything illegal, and I haven't been able to find a definitive answer anywhere.

Also, please note, this client didn't give me his insurance information. I was checking claims for another client when I found the clients information on accident.

I feel like I am in a very thin gray area here, and I'm not sure what I should do.

Thanks for your feedback!

 

[btadlock1]

So,
I have an interesting dilemma.

I work for a non-profit organization that treats private pay clients on a sliding fee scale basis. It is our policy that all clients seen on sliding fee scale must present their insurance information if and when they acquire it. We usually have client's fill out an authorization to bill insurance when the client's begin care.

I came across insurance on a client today who has insurance beginning 1/1/11. The insurance authorization I had was from 6/12/10 to 6/12/11. Is it ok for me to bill his insurance using the authorization as his visits we before 6/12/11? My boss is stating that we don't need the authorization to bill, but I don't want to do anything illegal, and I haven't been able to find a definitive answer anywhere.

Also, please note, this client didn't give me his insurance information. I was checking claims for another client when I found the clients information on accident.

I feel like I am in a very thin gray area here, and I'm not sure what I should do.

Thanks for your feedback!

You don't need their permission to bill their insurance, as long as they didn't pay full price out of pocket at the time of service. If they did pay full price, then they have the right to refuse any release of information about the visit to anyone, including their insurer. Just call the patient and ask them what they want you to do...I'm sure they'd probably be glad to have someone else pay the bill.

 

[jcochran]

Great to know! thanks so much for your help!!