Wiki Patient Responsibility

[mnelson2013]

Does anyone know if it is fraudulent to bill patient when insurance states they need additional information from the patient to process claim? Example I have is that the insurance is stating claim is still in "process" waiting for patient to call and verify if they have other health insurance. I call and talk to patient and they are going to call insurance to resolve matter but the "office" policy is to put balance toward patient until payment is rec'd from insurance or if patient pays balance.

Is this okay to do???? this is commercial insurance.

 

[jdyoutsey]

I have gotten a couple of these, and when I got them it stated that the patient was not responsible, nor was the payer. If I were you I'd check with the payer, as they may be different.

 

[LLynn29]

I would call the patient first and let them know that they may receive a bill because of COB issues with their health insurance carrier. The patient usually is aware that the the carrier is asking for information. Sometimes all they need is a little nudge to make the simple phone call. There's nothing fraudulent about that.

 

[dianafoster]

Usually when the client receives a bill, they are happy to contact their insurance company and get the questions answered!

 

[RFoster1]

I have always gone by the EOB. If it shows 'patient responsibility' then we bill the patient and usually include a form letter explaining why. If the EOB shows zero for patient responsibility, then I contact the payer and ask if it is ok to bill the patient. I take the rep name and a reference number, notate the account and send the bill.