Wiki Copays for visits denied for timely filing

[clarkmegan]

If a copay was collected for an office visit but the visit was never billed to insurance or the claim denied for timely filing, is the provider allowed to keep the copay? Technically an allowed amount was never adjudicated by the insurance company, so would it be wrong to keep the copay?

 

[plgorbulev]

keeping the copay

if you are a PPO... Man that phrase lol..... Is a no, you can not... Generally if you intend to bill the patient for the full amount then yes, if you are not contracted/PPO provider... But if you are contracted/PPO Provider and the Carrier is "dissallowing "the full amount you must do so as well... ( medicare is a definite NO) Hope this helps.

 

[thomas7331]

Your contract with the insurance company should be your 'source of truth' for an answer to this. I expect most contracts would say that could can only hold the patient responsible for the amount specified on the EOB, but I've also been told by providers reps in a few places that some contracts may allow providers to keep the copay. That said, I've never encountered any practices that actually refund or credit patients for copays when the rest of the claim has been denied and whether right or wrong, I believe that the most common practice is to write off just the balance due.