Wiki Weird Situation

reedguy1

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Anyone have any advice for this situation? Thanks in advance!

There was a couple with BC insurance. The patient was the dependent spouse who received about $20,000 worth of treatment in 2021 at this Texas practice. The BC was from another state (not sure which one at this time). BC did pay the practice for these treatments in 2021.

In 2022, the BC insurance recouped the $20,000 from the 2021 treatments.

It seems that the couple filed for divorce in 2020 and the divorce was finalized in September 2020. BC says that the dependent spouse was no longer covered as of the divorce in September 2020.

The patient did not advise the practice of this information or that they were no longer covered.

Does the practice have any options to try and get re-paid either through the BC or do they have to bill the patient directly or just eat it?
 
Anyone have any advice for this situation? Thanks in advance!

There was a couple with BC insurance. The patient was the dependent spouse who received about $20,000 worth of treatment in 2021 at this Texas practice. The BC was from another state (not sure which one at this time). BC did pay the practice for these treatments in 2021.

In 2022, the BC insurance recouped the $20,000 from the 2021 treatments.

It seems that the couple filed for divorce in 2020 and the divorce was finalized in September 2020. BC says that the dependent spouse was no longer covered as of the divorce in September 2020.

The patient did not advise the practice of this information or that they were no longer covered.

Does the practice have any options to try and get re-paid either through the BC or do they have to bill the patient directly or just eat it?


It's entirely possible that the patient didn't know they weren't covered.

I used to work for a company that did dependent eligibility audits - you wouldn't believe the number of divorced couples who have a friendly agreement to not term each other from the benefit plan. Not realizing that they can be retro-termed if a dependent audit is done & documentation is requested showing current proof of marriage. "I didn't know - I thought if I didn't drop them from my plan they could just stay on." Nope.

You can't get repaid by BCBS if the patient's September 2020 divorce made them ineligible as a dependent on that group plan.

First, I'd contact the patient and find out whether they had any other insurance for the DOS in 2021. If they did, I'd bill that with documentation of the BC recoupment date & hope the other insurer accepted that as proof of timely filing.

Otherwise, it's patient responsibility, and you'll have to bill the patient.
 
Anyone have any advice for this situation? Thanks in advance!

There was a couple with BC insurance. The patient was the dependent spouse who received about $20,000 worth of treatment in 2021 at this Texas practice. The BC was from another state (not sure which one at this time). BC did pay the practice for these treatments in 2021.

In 2022, the BC insurance recouped the $20,000 from the 2021 treatments.

It seems that the couple filed for divorce in 2020 and the divorce was finalized in September 2020. BC says that the dependent spouse was no longer covered as of the divorce in September 2020.

The patient did not advise the practice of this information or that they were no longer covered.

Does the practice have any options to try and get re-paid either through the BC or do they have to bill the patient directly or just eat it?
As mentioned above, contact the patient and find out whether they had any other insurance for the DOS in 2021. If they did, I'd bill that insurance with documentation of the BC recoupment date & hope the other insurer accepted that as proof of timely filing. There is a chance this will be denied due to timely filing since the DOS was so long ago. However, it doesn't hurt to try. While speaking with the patient about this, let them know if this is denied, it will be their responsibility to pay for this service. If the patient did not have another insurance, it's patient responsibility, and you'll have to bill the patient. It is also worth mentioning that if the BC plan was set up in manner that the patient did not need to be terminated simply from divorce, that you can fight this with BC. The patient would have to look into their plan and see if the divorce was did in fact make her ineligible. In the meantime, the patient needs to start making payments on her account to avoid collections.
 
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