Medical Billing Forum

Payments => Patient Billing => : isoto770 April 04, 2019, 08:16:14 PM

: Patient withholding insurance plan info
: isoto770 April 04, 2019, 08:16:14 PM
Very new to billing so i apologize in advance. Would like some advice on what to do when a patient withholds a primary health plan information. Example: Patient comes into office and gives us their medicaid insurance plan info. States this is their only insurance coverage; they have no other plan coverage, no other primary. Check eligibility via Navinet. No other plan info comes up. Patient signs all financial liability forms, reg. forms, etc. stating they dont have any other coverage besides what they provided us. We send the claim to that insurance plan. Plan denies it stating they are not considered primary for this patient and we need to bill the patients primary plan. We try to contact patient immediately to have their plan info straightened out so we can file in a timely manner. Of course cannot get ahold of the patient. Patient gets a bill for the unpaid service and complains that we are billing them. THeir medicaid plan says we cant bill the patient because we have to bill their primary (whichever plan that is since we still do not know). 6-9 months later patient finally realizes they did actually still have coverage with another plan and they give us the info. But now timely filing limit is passed for the primary. So who is responsible for paying for those service?

All help greatly appreciated
: Re: Patient withholding insurance plan info
: Michele April 09, 2019, 10:33:21 PM
Well I would still bill the primary and try to fight the timely filing based on the information below.  Not all companies would allow, but some might.  It's worth a shot.  The unfortunate part is that if the patient is Medicaid eligible it is most likely illegal to bill them even if it is ultimately their fault.  Which is another reason I would push for the primary to waive the timely filing.
: Re: Patient withholding insurance plan info
: Kerri June 24, 2022, 12:45:45 PM
Its patient responsibility.  If they don't give you the info, it is their responsibility to pay.  Medicaid denied saying other ins primary. You requested info, pt refused. PT PAYS.
: Re: Patient withholding insurance plan info
: Kerri October 12, 2022, 05:31:09 PM
Definitely patient responsibility.