Wiki Non participating provider

[Calva611]

I need help with an issue I have come across lately. My physician does not participate with many insurances so we collect payment at time of service and than we submit electronically on behalf of the patient indicating on the HCFA that the Dr is NON PAR and does not accept assignment.
Normally insurance companies pay out to the subscriber but we have run into some instances where the insurance company pays us directly instead of the patient. So than we refund the insurance company so they can properly process the claim and pay out to the patient. Some insurance companies are giving us a hard time and asking why can't we just refund the patient. The company policy is to refund the money to the insurance company. I was wondering if any one else runs into this issue and how do they handle it?

Thank you in advance.

 

[thomas7331]

Trying to compel insurance companies to change their ways is always going to be an uphill battle and a time-consuming task. I would think it would simpler to see if your company could change its policy. What is the rationale for this policy? I've never worked for a provider that had such a practice. If the insurance company makes an error and pays more than the full balance due, I can understand that the credit would have to go back to the payer, but if the insurance is paying amounts that the patient had already paid, I don't see a reason this couldn't be sent to the patients - you would only be refunding them from their own funds. The payments that insurance companies make on a patient's behalf are the patient's benefit to which they are entitled, so I don't know why it would be problematic to make these refunds directly to the patients.

But if that's not possible, another option would be to stop filing these claims to the insurance companies that don't follow the assignment of benefits correctly on your claims - you can provide the patients with a coded receipt for the services and require that the patients file for their own reimbursement and thus get your practice out of the loop entirely.