Wiki Can you bill patient when insurance denies inpatient auth

[cedwards]

I work for a private physician group. We provide consultation services to the local hospitals and bill our services through our private practice.

We often get denials from carriers as not medically necessary. When the hospitals exhaust all appeals and the denials are upheld can we as a private practice bill the member?

How do other practices handle this?

Thank you!

 

[JMeggett]

I work for a private physician group. We provide consultation services to the local hospitals and bill our services through our private practice.

We often get denials from carriers as not medically necessary. When the hospitals exhaust all appeals and the denials are upheld can we as a private practice bill the member?

How do other practices handle this?

Thank you!

Christina, you'll want to check with the insurance carrier that you got the denial from. If you're contracted with that carrier then you'll want to be very careful about what you make patient responsibility. Contact your Provider Representative at the insurance and explain the situation and see if they'll agree it's ok to charge patient.
Jenna