Wiki Billing patient for non-coverd services??

[l1ttle_0ne]

We have a case where we billed Humana for some pathology services (we do the TC portion of the pathology). The pathology codes were not on our fee schedule for Humana. So they are denying a couple of services for patients. Stating that it's provider write off. Our boss is telling us to transfer the balance to the patient. However we did not have the patient sign any non-covered services forms. This is the first time I've run into this. It's my understanding that if the insurance denies it as a non-covered service you have to have had the patient sign a waiver before services were rendered to bill them. Can anyone clarify for me??

 

[MarcusM]

If the provider is contracted with the carrier and the carrier denied per the contract, do you really want to balance bill the patient? I am biased in favor of the patient and would write this one off per the contractual agreement with the carrier, and then make sure I am ready for the next case like this and explain to the patient why they will have to pay for these type services, as well as review why the carrier will not cover these procedures.

 

[l1ttle_0ne]

If the provider is contracted with the carrier and the carrier denied per the contract, do you really want to balance bill the patient? I am biased in favor of the patient and would write this one off per the contractual agreement with the carrier, and then make sure I am ready for the next case like this and explain to the patient why they will have to pay for these type services, as well as review why the carrier will not cover these procedures.

Well that is how I and the other coders/billers feel. But not how our boss feel's. That's why I'm wondering if you can even bill the patient without a waiver being signed. We are contracted with the patients insurance.

 

[LCR CPC]

If you're contracted, the contract should spell out what your obligations are in these circumstances. Or you can try calling your Humana network rep.