We had two claims for the same patient denied due to pre-exisiting conditions. Diabetes type II.
There are two things that bother me about this.
1) Patient changed insurance to join a group plan through her employer. I didn't think there were pre-existing when enrolled in group health plans.
2) When checking benefits online through the insurance provider portal, there is no provision for checking pre-existing conditions listed on the site.
My question is, who's responsibility is it to make sure Pre-exisiting conditions are known by the provider. Patients? Insurance? Providers??
Should we as providers treat and not get paid to find out about pre-existing conditions. And if the pre-exisiting conditions aren't listed on the benefits portal with the insurance company, should they not be liable to pay.
Does anyone know if there are regulations or industry standard regarding this.
Chris
There are two things that bother me about this.
1) Patient changed insurance to join a group plan through her employer. I didn't think there were pre-existing when enrolled in group health plans.
2) When checking benefits online through the insurance provider portal, there is no provision for checking pre-existing conditions listed on the site.
My question is, who's responsibility is it to make sure Pre-exisiting conditions are known by the provider. Patients? Insurance? Providers??
Should we as providers treat and not get paid to find out about pre-existing conditions. And if the pre-exisiting conditions aren't listed on the benefits portal with the insurance company, should they not be liable to pay.
Does anyone know if there are regulations or industry standard regarding this.
Chris