Wiki Out of Network Paid to Patient

[Sarahlukkarila]

Hi,

Does anyone have any guidance at all on how to have better sucess with the paid to patient instances? We have so many claims that process and they pay the patient directly for Anthem specifically. It is really hard to collect these from the patients and want to know if anyone has any guidance on this or tips?

 

[LisaAlonso23]

We sent those patients three invoices to attempt to collect payment that was rightfully ours. If they didn't pay after that, we sent them to Collections.

 

[csperoni]

When we were a private practice, there were 2 insurances we were out of network that would not acknowledge assignment of benefits. We made it very clear to those patients before any services were rendered that they would receive a check from insurance and had 10 days to sign that check to over to us. We had them sign a paper acknowledging this and that if not done, the balance would be collected by legal means which would include small claims court or an attorney. I won't say a patient never kept a payment, but the vast majority were compliant. As soon as we were aware of a patient check, they received a phone call and a letter with very close follow up.
There were some patients we did take to small claims court. There were some patients who were sent to legal collections with an attorney. However, it was probably about a dozen on hundreds of patients over several years.
It is a tactic some carriers use as an attempt to coerce providers to be in network.