I have a situation in one of my client's ofc where benefits were called for a Medicare Advantage plan. The ins rep gave the benefits as covering not only manipualtions, but also PT, massage, etc. Obviously, MA plans don't cover these charges, but the ofc girl that called just thought "Wow, this is great insurance". SO the charges were billed and rolled to the patient and the ofc is saying "But we called and got benefits and they said it was covered" and the ins says "Yes, they have PT, etc benefits, but only if billed by a PT, not a DC so we didn't give incorrect info, you just didn't ask the right questions".
So that's the background for our patient that now has a significant balance and the doc isn't sure what we should do regarding writing the balance off as our mistake or discounting the services. I am on the fence with my inital reaction being - it's the patients responsiblitly to know theire coverage; then it is the ofc responsiblity to check into something that sounds too good to be true.
Any suggestions are appreciated!
Cara