Payments > Patient Billing

Service non-billable to patient



I bill for therapy services. I got an EOB back from Highmark that states the claim was rejected because benefits have been provided for the maximum number of sessions, no payment can be made. It also states that we cannot charge the patient for this service.

Does the patient really not have to pay?? Does it matter if the patient verbally agreed to pay for these services if insurance doesn't cover? In the future, if we have it in writing, can the patient be billed for those services?

Thanks for any help you can offer!

Hi Akl1424,

Good question!
Firstly, I think this could have been handled at the 1st stage of the RCM cycle, i.e. during the Eligibility-Verification stage. So, It's a definite Yes, the Patient doesn't have to pay and there is no charge on him. Sometimes, it also depends on the Insurance plan that the Patient has with them. Based on the plan, the patient may be entitled to a fixed amount of visits or sessions. So these details need to be verified at the initial stage of the RCM and then it becomes clear and more efficient.

If you need any help with the entire RCM plus EHR/EMR end-to-end billing solution, I can refer a great RCM agency that can handle all this. They are also offering free services for 1 month - called the Proof of Concept - Medical / Dental Billing Workshop.

Many times the eob indicates no patient responsibility but that is not always the case.  If the patient is only allowed a certain number of PT visits per year and they exceed that they are usually responsible.  It is the patient's responsibility to know their benefits.  PurviewHealthcare has a good point that it should have been verified prior to the start of treatment but since you didn't I would call to verify now what the benefit for therapy is and if the patient can be held liable.


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