Wiki Patient did not give insurance info for 2 yrs

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tsmith318

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Hello....

I am looking for specific laws (if there are any) to add to our internal policy and procedures.

Situation: patient was billed for 2 years and just called to provide insurance information (we are not contracted). I know that if I bill the insurance they will deny for timely, we could appeal but that's more money lost and we would have to adjust off. However, we told the patient that ultimately it is up to the patient to provide the information and due to the delay we can no longer file to the insurance (which is a courtesy in the first place). Does anyone know of anything in legal terms?

Thanks!
 
I do not know the legal rules but if you have documentation that the patient did not provide you with the insurance information and the fact that you are not contracted - this would remain in the patient responsibility. However, depending on the insurance, if you bill and appeal that you were just given the information you may get lucky and they might overturn their denial. I have done this many times with good results. But that was with contracted companies.

Plus for two years I assume he was receiving bills and gone to collections and now they are just calling!! That is absurd!

You have to weigh the pros and cons. The patient may never pay the bill or you can spend a little to try and get it paid.

Good Luck!!

Melissa Harris, CPC
The Albany and Saratoga Centers of Pain Management.
 
lack of contact with patient

Sorry with no contact with patient (even with all the attempts tried) = the patient is 100% totally responsible for it; double check your EOB and NRP the claims to be the patient's responsibility. Not to sound mean ....... the patient receives the SAME EOB you have received. If they are unhappy that they have to pay for xxxxx they really will call and tell you to review it and voice their opinion.
 
I would assume the patient went to collections a while back. At this point it is out of your hands if patient statements went out with no response.
I have had some success (depending on insurance) with patients who do not provide insurance in a timely manner, appealing with their insurance and explaining why they did not provide insurance. I have seen this result in insurances processing old claims.
 
Just to be on the safe side, when patients present for treatment and sign their informed consent, make sure you have language in there that indicates that regardless of their insurance status, they are responsible for their bill. (they are anyway....but it's nice to have a signed document).

I'm always surprised how people think it's ok to receive healthcare services and then just don't bother to pay for them. You wouldn't buy groceries or get a haircut and expect to get out of the door without arranging for payment. It's theft of services, plain and simple, but for some reason, healthcare services have been devalued to the point that some people think it's their right to be treated and not pay. This is a business we're running here.....

Off my soapbox now. :D
 
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