Payments > Patient Billing

Patient Billing Question

<< < (2/2)

Steve Verno CMBS, CEMCS:
To me, Looks like you found what i call a wolf.  A wolf is a patient who finds a practice that has weak financial practices.  They know how the system works.  So, they show, get the care and when they have to pay, they use threats and intimidation to get you to write off the bill.  They leave you and find the next provider to do this to.  I was brought in as a consultant to a provider.  A woman walked in, demanded to be seen. She provided an HMO insurance card.  I suggested they call her HMO.  They refused, so I called.  The HMO said the patient had to return to her HMO PCP.  When I mentioned this, the woman started speaking like mrs. Howell.  Young man, do you know who I am??  I put her on the phone with her HMO, they also told her she had to go to her HMO.  she refused and told her HMO she would be seen and they would pay the bill.  They said the claim would be denied.  She told the provider to treat her and send the claim to her HMO.  I rcommended what the HMO stated and I asked her to leave.  As she walked out the door, she yelled. "You'll be hearing from my attorney!!!"  The doctors wife was livid.  I tried to explain that the doctor would have provided the care and not be paid, in addition, she would never pay her copay, or deductible.  She never came back either.  I was asked to take on his billing.  Sadly, I refused.  This was part of his problem I identified.  The majority of his claims were denied for no authorization.  The HMOs refused to retro authorize.   

In most insurance policies, it is the patient who has the responsibility to ask if the provider is within or out of network.  The following is from an Aetna Policy manual:

If it is necessary, your PCP may refer you to a non-network provider for covered services that are not available within the network. Service from non-network providers require prior approval by Aetna in addition to a special non-network referral from your PCP.  You get benefits only when you are treated by providers in the network.  In order for a specific service to be covered under the plan it must be medically necessary for the
prevention, diagnosis or treatment of your illness or condition. In general, to receive care from a specialist or other provider who is part of the Aetna network you must first obtain a referral from your PCP.

I agree, e-mails should not be the method of communication regarding practice issues.  You state you have ben theatened.  This may be something that might need to be discussed with the practice lawyer. 

Navigation

[0] Message Index

[*] Previous page