Wiki Coinsurances adjustments

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ortho1991

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Please help

Is it legal to make adjustments on patients balance that are coinsurances left by their ins co.?

Any thoughts on this will be appreaicted.

Thank you, Cathy
 
Yes. It is a LEGAL obligation between the patient and their insurance company. You could be audited for not charging the patient their cost share.
 
Co insurance collection is addressed in the providers contract with the insurance company. It is a necessary portion of billing. Even out of network providers are legally obligated in most states to collect a patient's co insurance. Not collecting co insurance can be paramount to fraud by misrepresenting the cost of care. Always collect the patient's portion of their responsibility (deductible/coinsurance/copay). Write offs may only be done in documented instances of financial hardship. This would include proof of the patient's financial inability to pay. Even then, if contracted most insurance companies do not allow for this. Balance billing above the patient's coinsurance for in network is not allowed and for out of network, state by state laws govern this complex topic!
 
If the patient is about to go to collections, it is legal to discount the coinsurance responsibility. We recently changed the company we use for collections & this topic came up in our training. We cannot offer discounts when a patient first calls about their bill, however, if the choice becomes they pay 20% less or be sent to collections you can prove it was cost-effective for your company to provide the discount.

I initially questioned this, as I was under the impression that it would have legal repercussions. The company rep assured me this is totally legitimate.
 
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