Forum - Questions & Answers

Jun 20th, 2016 - thriverite

Insurance billing

We are a 3rd party billing company. We recently had a situation that we have not experienced before. A client had a patient who had a worker's compensation claim. After a period of time, the work comp company decided they would no longer cover claims for the patient as the treatment was not related to the injury. The patient contacted us and asked that we file with her health insurance. The doctor's office does not want to file with the health insurance but has not given us a reason for this or provided any written instructions. Since the patient specifically asked to have the claims submitted to the health insurance, wouldn't the doctor be obligated to file these claims at the patient's request? It is unusual that the doctor wouldn't file claims to this insurance as he is a contracted provider.

Thank you in advance for any information you may be able to provide.

Jun 21st, 2016 - dsteed   141 

re: Insurance billing

A letter from the w/comp will need to be obtained indicating specific reasons for continued non-coverage, and the effective date of this decision. The health insurance likely will not pay without this evidence. The patient may need to obtain it, or they may have already received. Either way, it must be obtained & sent in to the health insurer to be official in the patient's record. You cannot just begin to bill health insurance without this evidence. How would they know of this w/comp decision? This scenario is not at all uncommon. Surprised if you have not seen it before,

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