Copay on Unauthorized visits

vnorman

Networker
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I need some assistance, I have been taught that if you bill for services and they were denied due to not obtained pre-authorization that you can not keep the patients co-pay. Due to the services not being authorized it is not the patients responsibility and all services are to be adjusted off. Am I wrong? Was I taught incorrectly?

:unsure::rolleyes:
 
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St. Petersburg, FL
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Whenever we have gotten a denial for no prior authorization the EOB shows we have to adjust off the service completely with a $0 patient responsibility. So no the provider would not keep the patient's copayment. What does the EOB show?
 

vnorman

Networker
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This is exactly what I have been trying to tell my doctors however they do not like that one of the providers is not doing his job to get the service reauthorized for medical necessity so they want to keep the co-pay. I have tried to explain that there is $0 put to the patient so you can not keep their co-pay, the provider needs to do HIS job.

Thank you, I just needed confirmation that you can not keep the co-pay where the insurance puts $0 to the patient responsibility.
 
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