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!


Click here to post comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Your Questions.

Recent Articles

  1. Getting clients

    Mar 31, 18 09:47 AM

    Besides networking .. visiting their offices, how else can you attract their business? When you close the collections month, how do you bill the physicians?

    Read More

  2. Pricing for Claims Editing, Resolution, and Insurance Verification

    Mar 31, 18 09:36 AM

    I have a potential client that is requested claim scrubbing resolutions (only corrections on claims submission errors) and insurance verification on the

    Read More

  3. What to Do When a Provider Has a New Tax ID

    Mar 31, 18 09:28 AM

    The provider that I bill for just advised that he has a new tax ID. What is the process for this change? Would every insurance company need to be contacted?

    Read More

Disclaimer and Privacy

All-Things-Medical-Billing.com provides this website as a service. Please read our full Disclaimer and Privacy Policy here.


Copyright 2018 All-Things-Medical-Billing.com