Wiki Not covered services question

[jeaner54175@yahoo.com]

Our billing department is recieving statements from patients insurance companies (private and government) that say that a particular service is not covered. Do other facilities bill patients for those uncovered services or do they write them off. Patients will come in or call stating that they aren't going to pay for it even though the doctor ordered it and the patient recieved the service. The billing department is getting frustrated and wondered what other facilities do. Any insight would be helpful.

Thank you,
Lisa Nieft

 

[mitchellde]

non covered means the patient does not have benefits for that particular service, it is the patient's responsiblity to know what their benefits and what is covered. So YES you bill the patient every time. You do not need an ABN for non covered services however sometimes it is helpful to remind the patient prior to the service that this is not considered covered and the provider may decide to obtain a voluntary ABN. If however it is not covered due to medical necessity then you must have a signed ABN obtain prior to the procedure, if there is no signed ABN then this one must be written off.

 

[cheermom68]

The EOB should tell you whether the amount is patient responsibility or not. If it is not patient responsibility you would not bill the patient and would have to write it off.