Wiki WC and Commercial

[CMBA4]

Hi all,

Can you please help me out. Im trying to find out if it is ok to bill the commercial carrier if WC Carrier denies authorization for surgery as long as we have permission from the patient to do so? Or can the patient not have surgery at all since the carrier denied the authorization?

Please help

Thank you!

 

[mitchellde]

It depends on the reason WC declined to issue the authorizatipn

 

[brogdonlawn]

wc

We talk to the adjustor and get the denial from them in writing and then we can bill to commercial insurance. But you will need the denial to prove to the commercial insurance that w/c is not primary that it is not considered a work injury

 

[KMCFADYEN]

We do the same as Brogdonlawn.

 

[johnmeyer]

Same here in Jacksonville, Fl. Get in writing why W/C is denying prior to billing to commerical so they don't deny it saying it's for W/C.

 

[Acctcoder]

W/C in OH

I work for W/C MCO in OH and when authorization is denied, our MCO always sends letter explaining rationale for denial. If denial is not appealed by "party to the claim" (ie-Injured Worker, Atty, or Employer) then Provider may bill to private insurance using that denial letter.