Wiki Patient Responsibility

[mnelson2013]

Does anyone know if it is fraudulent to bill patient when insurance states they need additional information from the patient to process claim? Example I have is that the insurance is stating claim is still in "process" waiting for patient to call and verify if they have other health insurance. I call and talk to patient and they are going to call insurance to resolve matter but the "office" policy is to put balance toward patient until payment is rec'd from insurance or if patient pays balance.

Is this okay to do???? this is commercial insurance.

 

[Cyndi113]

In a past practice, if the insurance stated that they needed information from the patient...we would drop the claim to patient balance. If they get a bill staing they are responsible until the insurance receives the necessary information, they are more likely to call the insurance. If they can't see how much is being held up because of the needed information, a lot of patient's/families won't call. I would drop to patient balance.

 

[Miller913]

I agree with Cyndi, it should be patient responsibility. Most times the EOB from the insurance will show it is patient's responsibility. When I was a biller we always tried to contact the patient to inform them that the insurance is requesting info, if we never got a response we would then put the bill to the patient. Most times they would then call the insurance to find out why they did not pay.

Mary Miller, CPC

 

[vostrum1206]

We have had several situations with Blue Cross where they are pending the claim for group plan administrator. Usually this means that the insurance is waiting for the employer's HR dept to let them know the premium has been paid. I discussed this with our rep for BCBS and told her due to the length of these claims just sitting in limbo I was going to put them to patient responsibility. She agreed stating that would be fine and will help prompt the patient to contact them for further information or their HR dept.