Payments > Insurance Payments

PI non-payment

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DMK:
Here's a first for me.  We have a PI case, there is Med Pay, the claim was opened by the patient, it is NOT third party.  We saw the patient 8 times, then she failed to return.  She failed to follow Dr.'s orders.  She didn't return any phone calls.  We billed the insurance company following standard procedures.

When following up on the unpaid claim, the carrier says the case is "pending until the patient contacts them".  She has never returned their calls or our calls. 

I have sent a letter to the claim adjuster with this information noting that we would be happy to send treatment notes to verify treatment so we can get paid.  So far, nothing.  What can I do to get this claim paid?

PMRNC:
Nothing really, however... right or wrong, I sure would send the patient a billing statement for the full amount, that will at least get her to call you. I see no reason why you cannot do this. Is there an attorney on the case? Most cases I've dealt with had an attorney we could go through that really sped up the process :)

DMK:
There is an attorney (it's her friend) but it wasn't handled in the standard fashion.  I have called the attorney's office several times, but the attorney's assistant doesn't know anything about him taking the case and keeps telling me "I'll talk to him and call you back"....she never does.

PMRNC:
Then I would go about this as if there was no one going to pay and send patient a bill. You could enclose the documentation from the carrier where they have pended claims for receipt of information they need from the patient. Just seems like this might be a wash for the patient and they know it.

DMK:
Thanks, Linda, that's I how I was feeling about it.

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