My office provides a self pay service for a non-insurance covered injection. Patient's pay self pay price and then most of them ask for an itemized report that shows the diagnosis codes. However, we have 1 patient that requested the 1500 claim form which was provided to her. Patient took that claim and submitted it to her insurance (commercial plan) herself for reimbursement. The software generated the claim form with the "accept assignment" box checked(there isn't a way to uncheck this in our software) and now the provider has received payment from the insurance as well. The problem is they are reimbursing at such a low discounted rate because the codes they are basing it on are billable codes. But the true "self pay" codes are not able to be put on the claim (at that time, this problem has since been corrected to reflect the self pay codes)
We always tell our patients they are welcome to submit the claim themselves, but I have never encountered something like this.
Do we legally have to provide the claim 1500 form to patient if requested? Or is an itemized report sufficient?
We always tell our patients they are welcome to submit the claim themselves, but I have never encountered something like this.
Do we legally have to provide the claim 1500 form to patient if requested? Or is an itemized report sufficient?