General Category > General Questions

Expenses incurred during lapse in coverage

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abhilashanilkumar:
Could you help some what does mean by "Expenses incurred during lapse in coverage" and how can i resolve this denial.

Thanks in Advance,

Michele:
It means the patient did not have coverage at the time of service.  You must bill the patient.

david:
its means required insurance is expired. Patient is responsible for outstanding balance.

Nick D:

--- Quote from: Michele on September 21, 2020, 10:36:17 PM ---It means the patient did not have coverage at the time of service.  You must bill the patient.

--- End quote ---
Michelle,
If they try to recoup after a retro-termination. Do you refund the insurance the money or do you tell insurance company to contact patient? (ERISA question)

Michele:
According the the ACA it is illegal for insurance companies to do recisions unless the patient committed fraud or deliberately lied.  https://www.verywellhealth.com/health-insurance-rescission-2615206

However the issue is that if the provider participates with the insurance carrier they will just deduct it from future payments.

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