services not covered

[Trisha Reyes]

if a service is not covered by a pts. ins. does it automatically become pt. responsibility or is it the docotors office reponsibility to find out ahead of time if proceedure is not covered and does that mean that you can not bill the pt. for the non covered service ?

[Michele]

It depends on many things:

• What was the service
• Is the dr par with the insurance
• Is the insurance stating the patient can be billed

If the dr pars with the insurance and they state the patient cannot be billed, then they cannot bill the patient.  If they state the patient can be billed, or the dr doesn't par then yes.  It is good practice for a provider to find out ahead of time that something won't be covered and inform the patient.  It just makes for good relations with the patients.  Nobody likes to be billed for something that they thought was going to be covered.  But it is not a law, so if the insurance states the patient can be billed, then they can go after the patient.

Michele