Author Topic: Accurate Patient Info vs What Insurance Says  (Read 1296 times)

reneeh7

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Accurate Patient Info vs What Insurance Says
« on: May 18, 2013, 02:46:58 PM »
Hello all. I am very new at this and this is my first post. My question is: when filing a claim to commercial insurance, should you use the accurate information the patient provided, or use the inaccurate version that you see on the insurance eligibility check, such as date of birth or name or address etc. For example the patient's birthday is 03/15 but the carrier thinks it is 03/16, and the patient says they are trying to get them to change it in their system but it takes an act of Congress. Or the patient has recently remarried with a new last name but they still know her as the old.  Kinda dumb, sorry.

PMRNC

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Re: Accurate Patient Info vs What Insurance Says
« Reply #1 on: May 18, 2013, 08:15:25 PM »
You have to use the information known to be true and accurate.
Linda Walker
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reneeh7

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Re: Accurate Patient Info vs What Insurance Says
« Reply #2 on: May 18, 2013, 09:00:43 PM »
Thank you very much Ms Linda. I am very much in awe of you and this whole website.

RichardP

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Re: Accurate Patient Info vs What Insurance Says
« Reply #3 on: May 19, 2013, 11:37:52 AM »
We do billing in a market where there are multiple ethnic groups gaming the system.  They use multiple names and have multiple Social Security numbers.  I'm sure these markets exist in all large cities, and maybe smaller ones as well.  The doctors, the billers, and I'm sure other merchants must answer this question:  are we an arm of the government that it is our responsibility to verify whether our patient is in this country legally, or that the name and SSN provided is the one on file with the Social Security Administration?  (Actually, often multiple names and SSNs for one person are on file with the Social Security Administration.)

This reality is what leads me to exand just a bit on Linda's response You have to use the information known to be true and accurate.

As billers, it is our job to get for the doctor all the monies legally owed him for the services s/he performed for a given patient.  We know who that given patient is only because the doctor gives us the name of the patient.  As billers, we have no legal authority to submit to the insurance company any name other than the name the doctor gave us who was the object of his attentions.  It is not our legal responsibility to, nor can we, determine if the information the doctor gave us is true and accurate.  We just know it is the information the patient gave to the doctor, and we are legally bound to pass what the doctor gave us on to the insurance company.  Again, we have no legal authority to submit to the insurance company any name other than the name the doctor gave us who was the object of his attentions.

In a more normal situation, we sometimes will work with the patient to help straighten out issues with their health insurance company.  But that is pretty much limited to giving the patient phone numbers and names to call to straighten out their business.  No insurance company will change information in their system based on a request from us.  The request must come directly from the patient.