General Category > General Questions

Independent Review- Assistance needed (original issue in the 'No Preauth' thread

<< < (2/2)

PMRNC:
Ok, since not ERISA, you pretty much have exhausted with the State Dept / AG. The Customer service rep's are covered by their disclaimer that " benefits quoted are not a guarantee...etc., etc."  The services are  "NON" Covered as you found out with even the state dept of insurance. At this point, what I would do is bill the patient as there is nothing else you CAN do. In meantime you can let the IRO play out, I would say to cover the practice's butt and make sure patient understands you are doing this FOR them but bottom line they are responsible for out-of-pocket.

PippiT:

--- Quote from: PMRNC on July 18, 2017, 02:49:52 PM ---Ok, since not ERISA, you pretty much have exhausted with the State Dept / AG. The Customer service rep's are covered by their disclaimer that " benefits quoted are not a guarantee...etc., etc."  The services are  "NON" Covered as you found out with even the state dept of insurance. At this point, what I would do is bill the patient as there is nothing else you CAN do. In meantime you can let the IRO play out, I would say to cover the practice's butt and make sure patient understands you are doing this FOR them but bottom line they are responsible for out-of-pocket.

--- End quote ---

Yes, that is the plan but I have to come up with studies and documentation for Amnioband and anything I can find to submit to help our case for medical necessity. I've googled a few things that can't hurt but without the providers cooperation I'm afraid I will not have the proper documentation. In the end I've done my part so it's all I can do. 

I'm not sure what the doctor is planning to do  regarding billing the patient. I relayed the message from the AG that he needs to be thinking about that possibility. I guess he's waiting for the IRO to play out before deciding next steps.

Thank you for your response, it confirmed what I already thought! 

PMRNC:

--- Quote ---I'm not sure what the doctor is planning to do  regarding billing the patient. I relayed the message from the AG that he needs to be thinking about that possibility. I guess he's waiting for the IRO to play out before deciding next steps.
--- End quote ---

Depending on whether the services were rendered or not it might be a good idea to at least discuss the "Plan B" options. If this were my client or even employer I would definitely discuss the plan B immediately. I would also take into consideration what the patient was told prior to services if they were rendered. This isn't something I would only "wait and see" about if the costs are high. If services were already rendered with the patient believing they were covered, certainly there can be more discussion with the patient on payment.

Navigation

[0] Message Index

[*] Previous page

Go to full version