Payments > Patient Billing

What's the best way to collect from patients?

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PMRNC:
I am insured through a PPO Plan and we have $35 ER Copay with participating hospitals, I have noticed over past couple of years the intake dept wants the copay up front. The last time I went to the ER with my daughter I had overheard a woman say the hospital required her to pay her 20% up front.. I didn't want to infringe on her privacy but if that was me I would have asked hospital how I would be expected to pay 20% of charges that were not rendered or known! I can understand co-pay's, but not coinsurance.

I feel for you also, I would not want to work collections in any capacity for a hospital!!  :o

Linda Walker
PMRNC
www.billerswebsite.com

ajgallag:
How does a patient handle a situation where the provider has billed incorrectly and gets a denied claim because the ID number is wrong?
If the patient makes a reasonable effort to contact the biller and supply the correct id number, can the patient be held accountable and turned over to collections?
The insurance company says they can help with almost anything but cannot submit a claim for the provider.  Is the insurance company responsible to call the provider for the patient and help with this type of denial? 
I wonder how many other people are getting letters threatening collection for these types of situations.
Andy

Michele:
The patient is responsible to provide the dr with the correct insurance information in order for their insurance to be billed.  If that information is provided in a timely manner and the provider is in network with the patient's insurance company, then it is the provider's responsibility to get the claim in and processed. 

If I were the patient, I would make sure I not only provided them with the correct info, but actually gave them a copy of my ID card.  If I suspected a problem then I would contact the billing office and ask why they are not submitting my claim with the correct insurance info.  I would document all of my actions, when I gave them the insurance info, whenever I called the office, whenever I called the insurance carrier.  If the insurance carrier is indicating that they don't have the claim, or don't have it correctly, I would call the office again and advise them what the insurance carrier told me.  Ultimately if the patient does all possible and has it documented, and the provider is in network, the patient will not be help liable.  If the provider tries to bill the patient, the insurance carrier can terminate them from participation. 

Good luck
Michele

PMRNC:
 ???  But wait. If the claim was denied for incorrect ID #.. patient called, corrected it, the claim should have been processed.
Unless it was denied for something else I don't see what it matters who made the error, the claim should have been processed once the patient gave the carrier the correct ID #.

Michele:
I wish it was that easy with the carriers we deal with.  When most of our major carriers, BCBS, etc, receive claims with incorrect ID#'s they reject them electronically and no claim is ever in their processing system, so they can't just reprocess.  They require that we resubmit with the correct ID.  Sounds like this poor patient can't get the billing dept to just submit a claim with their info all accurate.  Doesn't seem like they should be having such a hard time does it?  We love when patient's call us with the correct info and we don't have to track them down! 

Michele

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