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Do you file a patient's insurance?

  1. #11
    Location
    Columbia, MO
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    Medical Coding Books
    the insurance adjusts premiums and benefits on the basis of a patients profile which is made up of the diagnosis we submit, then to not submit a claim is in fact hiding certain diagnosis from the payer. The patient may not want to be denied life insurance or is wanting to apply for a different job and does not want a condition to be pre exisiting. Think about things like HIV, STDs Cancer Hepatitis, we cannot not report these things and others to the patient's payer.
    Also FYI was not implying you were discounting the charges I just wanted to throw that in as it is something I hear often.

    Debra A. Mitchell, MSPH, CPC-H

  2. #12
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    Tacoma, WA
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    Quote Originally Posted by mitchellde View Post
    the insurance adjusts premiums and benefits on the basis of a patients profile which is made up of the diagnosis we submit, then to not submit a claim is in fact hiding certain diagnosis from the payer. The patient may not want to be denied life insurance or is wanting to apply for a different job and does not want a condition to be pre exisiting. Think about things like HIV, STDs Cancer Hepatitis, we cannot not report these things and others to the patient's payer.
    Also FYI was not implying you were discounting the charges I just wanted to throw that in as it is something I hear often.
    But the bottom line still is that the insurance belongs to the patient, not the provider. What about the case where they are new and don't tell you they have insurance? Or the insurance has changed and they decide not to tell you they have insurance? All the situations you described are true, but it is not the provider's responsibility to be the insurance police. Would you rather treat the patient and not bill the insurance, or risk the patient not receiving treatment because you refused their request to not bill insurance?
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #13
    Location
    Baton Rouge
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    Quote Originally Posted by mitchellde View Post
    the insurance adjusts premiums and benefits on the basis of a patients profile which is made up of the diagnosis we submit, then to not submit a claim is in fact hiding certain diagnosis from the payer. The patient may not want to be denied life insurance or is wanting to apply for a different job and does not want a condition to be pre exisiting. Think about things like HIV, STDs Cancer Hepatitis, we cannot not report these things and others to the patient's payer.
    Also FYI was not implying you were discounting the charges I just wanted to throw that in as it is something I hear often.
    Just 1 other point to this...if a patient is applying for life insurance, etc, the life insurance company should be requesting records from the provider, so they will likely find out about any conditions the patient may have by reviewing records, regardless of whether or not health insurance claims were filed.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

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