Medical Billing Forum

Payments => Patient Billing => Topic started by: lbd122 on June 29, 2009, 11:43:00 AM

Title: Patient Billing Question
Post by: lbd122 on June 29, 2009, 11:43:00 AM
Hi Everyone,

I have a question about how you would handle/word this.

We are OON.  I have a patient who we e-mailed after we checked their benefits telling them their OON benefit info.  Pt was surprised because she assumed that she would have a $20 copay just like at the previous facility she was at.  In her previous e-mail to another co-worker she said she assumed this and had she known the rate would be different she would not have switched over.  She apologized for the confusion and said she could not continue with our clinic.  In the e-mail we informed her of the current bill amount. We sent her a bill almost 2 months ago.  I sent her an e-mail recently confirming receipt of the bill because she had not responded at all.  She replied back to me stating she is disputing the bill because she talked to the owner before she started and he assured her she would only have to pay the copay amount.  I know for a fact that no conversation occurred and even in her previous e-mail to my co-worker it is evident no such agreement was made. 

My one concern is that she has the means to publicly badmouth our clinic.  I feel that pt is just trying to the pull the wool over my eyes since she corresponded with another co-worker before.  I want to e-mail her with the previous e-mails attached but I don't want to totally offend/anger her.  How would you word/handle the situation?

Thank you so much for responding!
Title: Re: Patient Billing Question
Post by: PMRNC on June 29, 2009, 01:04:12 PM
First of all, I probably would not get myself into a situation where patient billing and inquiries were handled via email unless they were general in nature. I'm assuming you have backed up correspondences with paper statements and letters via mail as well? Also I am assuming if the emails were sent they were sent using encryption technology if any PHI was transmitted?
If you have followed all protocol I would have to say you are covered.. I would check the office compliance manual to double check all procedures were followed accordingly. IF the patient does make any libelous statements or postings then the provider should seek legal counsel and advice.
Title: Re: Patient Billing Question
Post by: Pay_My_Claims on June 29, 2009, 02:48:05 PM
Unless you are in a management role, this situation should be turned over to them.
Title: Re: Patient Billing Question
Post by: Michele on June 30, 2009, 08:45:33 PM
I understand your concern.  The pt may not cross the line with their comments but if they tell their side of the story and it's not accurate it can do damage to the practice.  Depending on your role (whether you should be the one to decide) you need to weigh the amount of the bill with whether or not it is worth the fight.

Now, everything that PMRNC said is correct too, I'm not suggesting you should be quick to let this go, especially if you did everything correctly.  Ultimately it is the patient's job to know their insurance and what is going to be their responsibility.  But I do understand your concern.  If you are in a small area an upset patient whether right or wrong, can seriously damage your practice.  But it sounds like the patient has a certain type of personality that others are already familiar with, meaning that when they spout off, most likely everyone takes it with a grain of salt knowing what they are like.  If you know the conversation didn't take place you could let the patient know in a polite way that your office has no record of her being misinformed.

I'm kind of curios as to how big her bill is and if she was notified of what her responsibility prior to the services.  If not, that would be a good practice for the future, especially on OON patients.

Good luck
Michele


Title: Re: Patient Billing Question
Post by: Amit_Nischal on July 16, 2009, 09:05:04 AM
Totally agreed with PMRNC and Michele that  before approaching patient ensure that all the corrospondence made were PHI transmitted and weigh the $ amount see how much is worth to fight the bill. And of coarse look for office management protocal.

Thanks,
Amit
Title: Re: Patient Billing Question
Post by: Steve Verno CMBS, CEMCS on August 12, 2009, 07:44:40 PM
To me, Looks like you found what i call a wolf.  A wolf is a patient who finds a practice that has weak financial practices.  They know how the system works.  So, they show, get the care and when they have to pay, they use threats and intimidation to get you to write off the bill.  They leave you and find the next provider to do this to.  I was brought in as a consultant to a provider.  A woman walked in, demanded to be seen. She provided an HMO insurance card.  I suggested they call her HMO.  They refused, so I called.  The HMO said the patient had to return to her HMO PCP.  When I mentioned this, the woman started speaking like mrs. Howell.  Young man, do you know who I am??  I put her on the phone with her HMO, they also told her she had to go to her HMO.  she refused and told her HMO she would be seen and they would pay the bill.  They said the claim would be denied.  She told the provider to treat her and send the claim to her HMO.  I rcommended what the HMO stated and I asked her to leave.  As she walked out the door, she yelled. "You'll be hearing from my attorney!!!"  The doctors wife was livid.  I tried to explain that the doctor would have provided the care and not be paid, in addition, she would never pay her copay, or deductible.  She never came back either.  I was asked to take on his billing.  Sadly, I refused.  This was part of his problem I identified.  The majority of his claims were denied for no authorization.  The HMOs refused to retro authorize.   

In most insurance policies, it is the patient who has the responsibility to ask if the provider is within or out of network.  The following is from an Aetna Policy manual:

If it is necessary, your PCP may refer you to a non-network provider for covered services that are not available within the network. Service from non-network providers require prior approval by Aetna in addition to a special non-network referral from your PCP.  You get benefits only when you are treated by providers in the network.  In order for a specific service to be covered under the plan it must be medically necessary for the
prevention, diagnosis or treatment of your illness or condition. In general, to receive care from a specialist or other provider who is part of the Aetna network you must first obtain a referral from your PCP.


I agree, e-mails should not be the method of communication regarding practice issues.  You state you have ben theatened.  This may be something that might need to be discussed with the practice lawyer.