Wiki Timely filing when patient DID NOT update insurance

[MeanderingMichigander]

Howdy

A patient was originally seen about a year ago and provided no insurance information. They made a couple small payments on the 2 bills over the course of a year. Then, they called almost a full year after originally seen and, "Oh! Here's my insurance - bill it, please!"

Ugh.

So we did. And they denied it as being wellllllllll past timely. (I'll give you a minute to get over your shock.)

So... can we bill the patient for this because they DID NOT give us that info timely and we can back that up if need be?

We're having a differing of opinions here. If you say we can, please provide a link to some sort of reference for this.

Thanks!

 

[cgaston]

When I was billing I would appeal the denial with a copy of the patient statement and explain that the delay was due to the patient not providing us with their info in a timely manner. We repeatedly asked the patient for insurance information and he/she did not provide it.

I would then point out that when the patient provided us with the info on <<date>> we billed the carrier on <<date>> which is well within 90 days of receiving the information.

Good luck!

 

[Cheezum51]

Did the patient have coverage at the time of services or did they obtain insurance after DOS?

Kind of wondering why your billing staff didn't pursue this at an earlier date.

Tom Cheezum, O.D., CPC, COPC

 

[denisebailey44@gmail.com]

Helpful Information

When I was billing I would appeal the denial with a copy of the patient statement and explain that the delay was due to the patient not providing us with their info in a timely manner. We repeatedly asked the patient for insurance information and he/she did not provide it.

I would then point out that when the patient provided us with the info on <<date>> we billed the carrier on <<date>> which is well within 90 days of receiving the information.

Good luck!

Thank You because now I will try this when I am billing. Did the insurance Companies pay after receiving proof that it was on the patient?

 

[MeanderingMichigander]

They had active coverage on DOS but they didn't tell us until 10 months after the fact. We had it as self-pay until then and the patient had made a couple payments, so we had no reason to think otherwise until they contacted us and said, "Oh hey, I had insurance, actually!"

We have tried appealing before but it hasn't been successful.

That's why I'm questioning whether it would be able to be returned to patient responsibility at this point, since they didn't give us the information until it was way past being timely to bill the insurance.

 

[arieljones1995@gmail.com]

I don't think you could bill the patient because you filed with the insurance company. I would just use all levels of appeal until it's exhausted.

What we do at our clinic is required patients to sign a form stating they are self-pay and insurance will not be billed on date of service. So even if they come back at a later time, I tell them that we are not required to bill due to them signing this form, but I, of course, will bill any dates of service to that insurance going forward.