Wiki Reimburse patient copays??

[BECKY LEVI CPC]

Recently a new physician has started with our practice. He has been seeing some patients he is not yet credentialed with their insurance. Copays have been collected at the time of service. If the insurance company comes back and states he was not credentialed or for claims that may be untimely, are we required to reimburse the patient their copay?

 

[RenaHall]

You should be informing the patients that this particular provider in not contracted. The insurance should not come back and tell you to refund the patient since the claim will be processed as non-par. Check your contract to see if the new provider can see patients in an urgent situation as a network provider and save him/her for work in appointments.
Rena

 

[ritas927]

You may have to write off the balance though (not legally because they did receive a service, just good customer service and good business). If the insurance company pays non par, the reimbursement rate is usually less therefore leaving the patient a balance that they would not ordinarily have for a participating provider. It is always best to let the patient's know up front that a provider is non par, so the patient can make a decision as to whether or not they want to see said provider.