Billing the Responsible Party

What are the rules for the patient being the guarantor?


It depends on the patients policy but typically the patient is responsible for co-pays, coinsurance, and deductible. The coinsurance is the amount (or percentage) the patient is responsible for.

So after the insurance is billed and pays what they are contractually obligated to, the patient is billed - after the write-off per the insurer. There's also the deductible which the patient is responsible for.

The Explanation of Benefits (EOB) should explain all the deductibles, co-insurance, and write-offs for each patient dependent on the policy.

We typically bill the patient after entering the information from the EOB.

Depending on the providers policies, if the patient balance is past due, past due or warning statements are sent to the patient. If the balance is still not paid, then they can be turned over to collections and its treated like any other debt. Again this is entirely up to the provider. Some may choose to write off amounts below a certain threshold.

Hope this answers your question.


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