Wiki Claim Denials for no authorizations, patient responsibility?

[JesseL]

If a claim gets denied for failure to obtain authorization, will the patient be responsible for charges or is it the provider that has to foot the cost of treatment?

 

[letitiadickerson@yahoo.com]

denial for authorization

Hey Jesse
If your DR did not get authorization for the services then the doctor will not get paid and you can not bill the patient because it is the DR responsibility to obtain precert/authorizations. Sometimes if a referral to see a specialist is needed, the DR should get the referral also but ultimately you can not bill the patient. You may want to call the insurance company to ask if you can bill the patient or on your denial EOB it will state patient responsibility or provider write off/adjustment and you can tell from there how to handle. But if you bill the patient they can appeal to the insurance company and find out that your office did not do their job in getting the authorization and you will look unprofessional when billing a patient that is truly the DR responsibility.

Hope that helps

 

[KristieStokesCPC]

Try to call the insurance before adjusting, depending on the insurance you may be able to obtain a retro authorization/referral.