Wiki Humana denial- Looking for guidance.

[toots9798@hotmail.com]

I'm confused about forwarding billing onto patients with Humana. My practice is asking that I forward non-covered services to the patient when they are denied by humana plan. Since it is a Medicare replacement, can I do that? I thought it had to be written off because it is denied by insurance. Its for visit/evaluation with our dietician.
What about labs that get denied by Humana plans, can those be forwarded to patient.
Thank you in advance for your help!

 

[thomas7331]

The EOB from the Huaman plan should tell you whether or not you can bill the patient. If the plan has denied the claim as provider responsibility with no patient liability, then in most cases you cannot legally bill the patient.

Under the laws governing Medicare Advantage plans, even if a provider is out of network, they usually have to comply with the plan's requirements. If the provider was aware of the patient's coverage prior to treatment and agreed to file the claim on behalf of the patient, the provider is 'deemed' to have accepted those requirements and would have to accept the terms of payment that the Advantage plan has determined for that service.