Author Topic: Kaiser denial  (Read 2284 times)

Navymom

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Kaiser denial
« on: May 10, 2012, 06:16:56 PM »
When my doctor sees a Kaiser patient in the ER of the community hospital the claim is denied with the notice that I can appeal if the doctor will sign a waiver not to bill the patient.  It is always an emergency, Kaiser always denies and my doctor will not sign a waiver and tells me to bill the patient.  I want to know if I can bill the patient?

PMRNC

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Re: Kaiser denial
« Reply #1 on: May 11, 2012, 08:27:10 AM »
Is the provider par or non par? What type of denials are these?
Linda Walker
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Navymom

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Re: Kaiser denial
« Reply #2 on: May 11, 2012, 09:29:17 AM »
Hello,  My doctor's are non par, these are Kaisers HMO patients that most are elderly and have cronic medical problems which brings them to the hospital in an ambulance with the ER doctor doing an accessment.  My doctor's are Internal Medicine and are called in to consult and take care of any issues in their field.  The denials are always the same, "Additional time spent to reach a Plan provider would mean risking permanent damage to your health.  Use of non-Plan providers in non-emergency situations is not payable by Kaiser Foundation Health Plan, Inc.  To file an appeal you must first agree not to bill the patient and complete a Waiver of Liability Statement which is your attestation that you will not bill the member regardless of the outcome of an appeal". I have a file full of Kaiser patients that were seen for a day or two to stabilize and transport but this is standard for Kaiser so we will go away.  All documentation proves the emergency.  Any help would be appreciated.

PMRNC

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Re: Kaiser denial
« Reply #3 on: May 12, 2012, 07:40:50 AM »
Quote
To file an appeal you must first agree not to bill the patient and complete a Waiver of Liability Statement which is your attestation that you will not bill the member regardless of the outcome of an appeal". I have a file full of Kaiser patients that were seen for a day or two to stabilize and transport but this is standard for Kaiser so we will go away.  All documentation proves the emergency.  Any help would be appreciated.

Seriously? And that's legal? I've never heard of such a thing but then again I've heard wicked things about Kaiser..  Well, it sort of sounds like blackmail to me but what do I know. I would probably advise my patient to bill patient's and let them appeal with the insurance company. Seems to me the patient is going to have a better shot of an appeal since they were unaware of the participating status nor it doesn't seem they had a choice in the matter. Also the provider knows he wasn't par, so that's my best advice, follow through with billing to the patient, maybe offer them the documentation they need to file the appeal.  I wouldn't advise my client to sign any type of waiver without knowing they are going to consider the charges, that's nuts!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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Re: Kaiser denial
« Reply #4 on: May 13, 2012, 04:03:20 PM »
I actually have heard this.  I agree, doesn't seem legal.  I agree with Linda though, if it were my client I wouldn't want to advise them to sign the waiver.  But I have had one provider (only had one patient) agree to do this.  We are still waiting on the outcome. 
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PMRNC

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Re: Kaiser denial
« Reply #5 on: May 13, 2012, 04:05:46 PM »
Why would a provider do this.. it's like asking them to shoot craps, when they have a better shot at billing patient and them going after the appeal? The patient always has a better shot at any appeal than the provider!
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Navymom

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Re: Kaiser denial
« Reply #6 on: May 14, 2012, 09:43:09 AM »
Thank you all for your replies.  I am going to have the biller start sending out the statements and then I guess I will fight from there if we get any nasty letters.