Medical Billing Forum

Payments => Insurance Payments => Topic started by: DMK on March 22, 2012, 11:51:56 AM

Title: PI non-payment
Post by: DMK on March 22, 2012, 11:51:56 AM
Here's a first for me.  We have a PI case, there is Med Pay, the claim was opened by the patient, it is NOT third party.  We saw the patient 8 times, then she failed to return.  She failed to follow Dr.'s orders.  She didn't return any phone calls.  We billed the insurance company following standard procedures.

When following up on the unpaid claim, the carrier says the case is "pending until the patient contacts them".  She has never returned their calls or our calls. 

I have sent a letter to the claim adjuster with this information noting that we would be happy to send treatment notes to verify treatment so we can get paid.  So far, nothing.  What can I do to get this claim paid?
Title: Re: PI non-payment
Post by: PMRNC on March 22, 2012, 06:21:07 PM
Nothing really, however... right or wrong, I sure would send the patient a billing statement for the full amount, that will at least get her to call you. I see no reason why you cannot do this. Is there an attorney on the case? Most cases I've dealt with had an attorney we could go through that really sped up the process :)
Title: Re: PI non-payment
Post by: DMK on March 23, 2012, 10:42:16 AM
There is an attorney (it's her friend) but it wasn't handled in the standard fashion.  I have called the attorney's office several times, but the attorney's assistant doesn't know anything about him taking the case and keeps telling me "I'll talk to him and call you back"....she never does.
Title: Re: PI non-payment
Post by: PMRNC on March 23, 2012, 11:34:43 AM
Then I would go about this as if there was no one going to pay and send patient a bill. You could enclose the documentation from the carrier where they have pended claims for receipt of information they need from the patient. Just seems like this might be a wash for the patient and they know it.
Title: Re: PI non-payment
Post by: DMK on March 23, 2012, 11:41:42 AM
Thanks, Linda, that's I how I was feeling about it.
Title: Re: PI non-payment
Post by: AdvancedSpine on March 28, 2012, 10:08:52 AM
In florida If the patient signed an assignment of benefits when she registered with your office, you can turn it over to an attorney to place a demand and collect it from the insurance company.  This is a no-fault state so, I am not sure how your PIs work where you are but this always works for me.
Title: Re: PI non-payment
Post by: PMRNC on March 28, 2012, 11:15:13 AM
The insurance carrier has the claims, they are holding up for information from the patient, so no demand letter is going to work demanding it from the insurance company, the carrier of course has done their diligence by "pending" the claim and have a right to hold until they have all the info they need for a claim decision. Her best recourse is collections via the patient because there technically is NO case since she A) opened it herself B) failed to respond to requests and C) did not follow dr orders.
Title: Re: PI non-payment
Post by: DMK on March 28, 2012, 11:26:58 AM
The happy ending is that nagging the attorney's office 5 or 6 times worked.  I got my check on Monday!!!!!  I had my letter to the patient, copies of her signed agreement to pay, copy of the EOB showing the claim pending information from the patient, all ready to go, stamped and addressed.  The mail man picked it up when he dropped my mail and there was the check! So I nabbed him and got the letter back!

I am SO glad I didn't have to start that nasty collection process.  My faith in humanity is restored!  Well, this lady at least. :P
Title: Re: PI non-payment
Post by: PMRNC on March 28, 2012, 03:44:25 PM
Good Deal! Did carrier pay or was check from patient?
Title: Re: PI non-payment
Post by: DMK on March 28, 2012, 03:57:20 PM
The insurance company paid, so the patient must have FINALLY called them.  I'm so grateful I can't even tell you!