Do copays have to be refunded when claim is denied ?

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Author Topic: Refunding Copays  (Read 2461 times)


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Refunding Copays
« on: December 15, 2010, 05:30:28 PM »
I have two billing managers one states that we have to refund copays if claims are denied due to untimely filing. On the hand I am been told that no we do not refund because services where rendered and patient was responsible for paying copay. So far neither has been able to prove in black & white Any suggestion with this would be great, by the way we are in California.


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Re: Refunding Copays
« Reply #1 on: December 16, 2010, 06:41:30 AM »
Usually the contract between the provider and the insurance carrier will state that the patient cannot be charged for copays/coinsurance if the provider does not follow thru on their end of the claim (timely filing, authorization obtained, etc.).

I would suggest looking at the contracts.

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Re: Refunding Copays
« Reply #2 on: December 16, 2010, 08:31:20 AM »
I agree with Michelle you have to look at contracts. I have seen contracts where the patient is responsible for copay's with the only stipulation that the services were rendered. 
Linda Walker
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