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Thread: Need help with no longer par with insurance

  1. #1
    Join Date
    Apr 2007

    Question Need help with no longer par with insurance

    AAPC: Back to School
    I need some help with some information for our office. We are a specialist office and starting this year we are no longer participating with medicaid mco's. Are there any rules as to having to still see an existing patient that has previously had surgery but not in the global period? My boss seems to think that we still have an obligation to see these patient but we are not getting paid for any visits. I think that we should only have to see them if they are within the global period of surgery. Any help or suggestions where to look would be greatly appreciated.

  2. #2

    Wink tlcbiller

    While your Doctor may have compassion for the patient and may want to continue to treat any and all problems that arise it is not a good idea. The Doctor is taking a risk, both Professional and Financial, encouraging a non-paying patient to continue the Doctor-patient relationship. If some goes "wrong" and the patient believes they have been harmed, there will be a lawsuit. If the Doctor continues to treat on a no-pay basis then there is no justified reason why all other potential patients without insurance can not be treated by him as well (perhaps another lawsuit). And finally, since there are expenses to be paid and this is a business, it should be ran as such.

  3. #3


    On the same token too, if the patient is having surgery , is out of the global and is still having problems, is it right to just cut that patient off? I would try and get an oon referral or tell the patient that the dr will continue to treat them until they find another provider. It is difficult for a patient to find another dr that will take over their care if they have had surgery from another dr. especially if they are having complications.

  4. #4
    Join Date
    Apr 2007


    Thanks. I feel the same way. Do we need to send a letter discharging them from the practice or can we simply tell them we no longer participate with their insurance when they call to schedule an appointment? I know that if a patient has an unpaid balance and refuses to pay, you must sent a letter to them dismissing them from the practice.

    Penguins11 - thanks also. I agree with you that if it is a problem with a previous surgery but how long after surgery would you still treat them. To clarify alittle, we are neurosurgery, so after the patient has had surgery and 6 months or a year has passed, they may still have back pain or neck pain etc. In some cases, they would need revision surgery which then would not be paid. We have done some single case agreements with this insurance company for some surgeries that were scheduled prior to non par but performed after we were non par and have been fighting with the insurance to get them paid. So I guess my main question would be how long would you continue treatment for free?
    Last edited by mls5502; 01-27-2012 at 06:25 AM. Reason: added info

  5. #5


    We are neurosurgery as well and I agree that this is a tough situation. Really with each patient, the dr should make that call as he/she is the one at risk. For the ones the dr. decides to continue to treat I would try and get the oon authorization. For the ones that the dr. feels can go to another provider I would send them all letters saying the dr will provide treatment for 30 days and that you will be glad to transfer their records to another neurosurgeon. If you didnt send all of your patients a letter giving them plenty of notice that you would be nonparticipating, if this ever comes up in the future I would send all of your patients a letter giving them 90 day notice that you are going to be nonpar.

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