Wiki Billing Question

[Cindyrev67]

I recently recieved several denials from a commercial policy because our physician was non participating and we did not obtain prior authorization. By law, can we still collect or bill the patient for their copayment? Many of the patients paid their copayment at the time of service and I'm wondering if we're obligated to refund their money. Hope someone can help.

 

[ajs]

I recently recieved several denials from a commercial policy because our physician was non participating and we did not obtain prior authorization. By law, can we still collect or bill the patient for their copayment? Many of the patients paid their copayment at the time of service and I'm wondering if we're obligated to refund their money. Hope someone can help.

Can you get retroactive authorization for the services that were provided? If not, and if the patient was not informed at check in that your physician was non-participating, you will probably have to refund the copays. You should check with your state insurance commissioners office to see if there are specific guidelines regarding that situation. But in general, physician offices have a responsibility to determine that they are a participating provider on the patient's insurance policy before rendering care. If they are not, the patient needs to be informed.