Claims and deductibles

by Daniela DiMarco-Healy
(Phila, PA)

So where does the responsibility of the biller end? When a claim processes with a deductible applied and the patient believes it is incorrect, is it the patient's responsibility to call insurance and address it or is it mine?


I know if a claim processes wrong for other reason, I call to have that claim reprocessed correctly, but strictly as a biller, should I be the one calling to confirm deductibles?

Response:

From our experience, when we file a claim, the insurance company applies the patients deductible before paying the claim and applies the allowed amount to their deductible. Once we receive the Explanation of Benefits (EOB), we note this on the account and bill the patient for any balance. The biller is basing these charges on the information the insurance company has provided on the EOB.

Once the biller does their job, I think it is up to the patient to call their insurance company and investigate if they don't agree with the posted charges or deductible.

Thanks for your question.

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