Author Topic: ethical vs. unethical  (Read 1191 times)

rdmoore2003

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ethical vs. unethical
« on: October 07, 2013, 02:03:51 PM »
In my state, there is an insurance company that is basically operated by area physicians.  This company has been around for some years now and an issue came to my attention today, and I am not sure how to take it.  This insurance company also takes care of medicare members' benefits as well.   The insurance company does not cover psychological testing, unless it is a medicare patient.   Just so happens, we have a patient that his dad either sits on the board and/or is an employee of the company.  The patient's mother called and wants a detailed invoice/superbill so that she can file to the claims department because of her husband's affility she can get reimbursed.  Doesn't this constitute an ethical issue?  Can the insurance company get away with paying a claim for an employee/board member for something that is not covered any other time for any other patient?
Regina

PMRNC

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Re: ethical vs. unethical
« Reply #1 on: October 07, 2013, 02:16:05 PM »
Could be an ERISA plan to which patient's have much more say with administrators / board than commercial/ group.  Whatever your office policy allows for.. collect what is in accordance with the office policy and then submit as courtesy as the patient has requested.

Linda Walker
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rdmoore2003

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Re: ethical vs. unethical
« Reply #2 on: October 07, 2013, 03:26:46 PM »
Thanks Linda
Regina