Forum - Questions & Answers

May 20th, 2009 - pbrown01

No authorization on an inpatient hospital stay

Our doctor billed for professional fees for an in-patient stay that the insurance company has denied for no authorization. The pre-authorization should have been handled by the hospital staff and wasn't. Can we bill the patient for these services or is there a better alternative? Thanks

May 20th, 2009 -

Did you appeal?

I am sure the hospital appealed the denial. If it was a medically necessary stay then the insurer is likely to pay it. But if the hospital appeals and gets approved for the stay, they most likely won't call you to tell you to rebill. So you may want to do the appeal yourself.
Then again, if your doc is the primary care doc who was supposed to precertify the stay and she did not then you may be out of luck. And if the stay was determined to be not medically necessary then you are also out of luck.
You cannot make the patient pay- that would breach your contract.

May 20th, 2009 -

Oh yeah...

and don't blame the hospital staff- the doctor is supposed to notify the insurer- read the contracts- it's there.



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