Claim billing

[maryt310]

Hi,
I have a patient who insisted he did not have health insurance. Still, the claim was workers' compensation, we verified the claim and was open, so we did not have to have the patient sign an ABN. The workers' comp denied, then the member told us yes, he does have insurance. Still, he would have needed a precert for the MRI. Do we have to submit this claim to the health insurance? We know it will be denied for no authorization. or can we just bill the member
thanks

 

[toria11]

Hi! You have to bill the patient's health insurance. You can't bill the patient as self pay when they have health insurance.

 

[Pam Warren]

Bill the insurance first. Then when you get the denial, balance bill the patient. They are responsible for all services that they present for, but you do need to do your due diligence before you drop the claim to the patient. And if you participate with the insurance company, your contract with them requires you to do so.