Is it right to bill a patient for co-pays, deductibles, or co-insurance amounts they did not know they had at the time of visit?

by Anonymous
(California)

I am going over claims that were already paid by the Insurance but still show a balance because of patient responsibility. I ask If I should still bill the patient because the patient was not advised of their payment responsibility at the time of service.


These claims are about 3 to 6 months old. Which brings me to my next question. Are we obligated to let the patient know of any amounts they are responsible for before they see the Dr.?

Response:

We have billed for patient responsibility going back up to two years. This was a situation where many patients had not been billed for their co-pays, co-insurance, deductible, etc. This was a situation where the billing had been neglected for a long time and the patients had not been billed - sounds similar to what you are describing.

In our case we sent out a letter with the patient statements explaining that there were problems with the billing process and why they were just now getting billed.

The approach you take on this depends a lot on the provider and how much they want to risk angering their patients - or if they just want to write it off and do things right going forward. In our case the provider wanted to try to collect for the past 2 years.

There's also the issue of the insurance carriers timely filing policies - and of course they are all different. If the claim wasn't filed in time, it's really hard to justify billing the patient.

As far as letting the patient know what their responsibility is - it's really the patients responsibility to know what their co-pays, co-insurance, deductible, etc. are and the specifics of their policy.

It is a courtesy of many front office staff to check eligibility up front. But many smaller providers don't have the staff to do this as you know it can be time consuming.

It is complicated as many insurance policies change annually - and they have different patient responsibilities. So the patient many times doesn't know what the terms are or that they changed.

Hope this answers your question. Thanks for visiting the site!


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