Question Claim becomes timely due to member providing incorrect insurance information

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I work for a pediatric clinic in Washington state. If a parent fails to provide correct insurance information for their child until after the claim would be considered timely filing (and we are contracted with the patient's insurance), is there anything we can do to receive payment? Or does this get chalked up to a free visit due to the parent's negligence? We would have exhausted all means to get this information. In some instances have billed the parent directly and they have paid, only to call months later to say they had insurance during that time.
 

chrissyfegan

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I'm in Texas but I have had success in the past with an appeal letter explaining what happened. It has also helped if the parent will write something and/or call the insurance to corroborate, as well. Sometimes I had insurances process the claim at the request of the parent/subscriber, without an appeal. Sometimes insurances won't pay but will allow you to collect from the patient. And sometimes they will just deny and you have to eat the cost. Good luck!
 

csperoni

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I agree - it is certainly worth the appeal letter. I have had successful appeal for this, and included the demographics sheet signed by patient with the wrong insurance information there. In your appeal letter, include the days/times you called, or sent letters to the patient/parent, etc.
 

vanessamoldovan

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I work for a pediatric clinic in Washington state. If a parent fails to provide correct insurance information for their child until after the claim would be considered timely filing (and we are contracted with the patient's insurance), is there anything we can do to receive payment? Or does this get chalked up to a free visit due to the parent's negligence? We would have exhausted all means to get this information. In some instances have billed the parent directly and they have paid, only to call months later to say they had insurance during that time.
In my experience, the patient can successfully appeal this with the payer. The payer will usually not care what the provider appeals. As far as whether you bill the patient or not, that depends on the payer contract guidelines and internal office procedures.
 
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