Medical Billing Forum

Payments => Insurance Payments => Topic started by: ellie on August 01, 2010, 05:47:47 PM

Title: WORKER'S COMP
Post by: ellie on August 01, 2010, 05:47:47 PM


 I have a scenerio-  pt came in to ASC- Patient stated on the registration form that this was a work related injury. Primary insurance was billed and they paid. They are now wanting to recoup the money back. I called the claims adjuster for retro- approval for workers comp. She stated that she did not approve the patient to our facility and that the patient had been taking it upon herself to go wherever she wanted. Anyone know what the guidelines are on this. Thanks for your help.
Title: Re: WORKER'S COMP
Post by: DMK on August 02, 2010, 10:23:11 AM
I don't know what state you're in, but in California, that's known as "self procured care".  If you can get a written denial from the W/C insurance company you can send it with a letter to the patient's health insurance indicating that the W/C insurance denied your services.

If anything, the patient may have to pay for his "self procured care". 

Patients have a right to go anywhere they want, but the W/C ins. co. doesn't have to pay for anything that wasn't authorized.

The patient's Primary treating physician could request treatment at your office and get it retroactively authorized, then you could re-bill the W/C insurance.
Title: Re: WORKER'S COMP
Post by: Michele on August 02, 2010, 08:41:28 PM
You should also check your state laws.  If the patient indicated on the intake form that the claim was work related, it should have been caught before the primary insurance requested a refund. 
Title: Re: WORKER'S COMP
Post by: ellie on August 08, 2010, 08:08:56 PM
thank you Michelle-  in that case is the patient still liable for the bill ?
Title: Re: WORKER'S COMP
Post by: PMRNC on August 08, 2010, 08:22:45 PM
We still don't know what state your in, you have to check your state laws.