This is not an acceptable business practice and I believe telling a patient "I have checked with your insurance and this pillow is all you need to pay for" could also be considered fraud or at least extreme misguidanceI would never have proceeded with treatment if this statement had not been made to me Regards, [redacted] ***
After the patient finished with her consultation/examination, she came up to the front deskI said to her "all procedures are covered with the exception of one item, the pillow because insurance considers it a durable good." The paper she signed is called an "Advance Notice" sheet which is required
by the insurance company for the provider to present to their insured for any services not covered/paid for by the insurance companyThe patient signed the paper with the understanding the pillow would not be covered/paidWhen I said "everything is covered minus the pillow" what I meant was the standard definition of "covered" in insurance languageThis means the insurance company believes the billed procedures are medically necessary and will be paidPayment is considered a multitude of ways by the insurance company; they do this by applying charges to deductibles, co-pays, co-insurances as well as issuing checks/EFT.DrAustin has a contract with ***I do not check patient's benefits (the amount of their deductibles, co-insurance amounts,etc.)when they are insured by *** because I KNOW THE INSURANCE COMPANY WILL NOT DENY THE BILLED PROCEDURESThey will either issue payment via EFT or check to DrAustin or apply the benefits to deductibles, co-pay and co-insurance amountsThat is the definition of "covered."If it wasn't "covered," the insurance company would DENY the services and pay nothingClearly the procedures were covered because the balance due is the patient's deductible and/or co-insuranceThe patient signed up for this insurance plan leaving me confused as to why she thinks she isn't financially responsible for her portion. It is the patients responsibility to know their insurance benefits, what their deductible is, what their co-insurance amount is, etc. After working for DrAustin for years, I only check insurance benefits for patients who have medical insurance in which DrAustin is not a contracted providerI don't have the time to check patient's benefits when they have insurance with a contracted insurance company.Regardless of our relationship with the insurance company, I AM NOT PERMITTED TO WRITE OFF BALANCES THAT ARE THE CO-PAY, CO-INSURANCE, DEDUCTIBLE, ETCIT IS ILLEGAL AND UNETHICALA DOCTOR CANNOT CHARGE THE INSURANCE COMPANY ONE AMOUNT AND THEN TURN AROUND AND CHARGE THE PATIENT NOTHINGTHAT IS CONSIDERED FRAUD
This is not an acceptable business practice and I believe telling a patient "I have checked with your insurance and this pillow is all you need to pay for" could also be considered fraud or at least extreme misguidance. I would never have proceeded with treatment if this statement had not been made to me.
Regards,
[redacted]
This is not an acceptable business practice and I believe telling a patient "I have checked with your insurance and this pillow is all you need to pay for" could also be considered fraud or at least extreme misguidanceI would never have proceeded with treatment if this statement had not been made to me Regards, [redacted] ***
After the patient finished with her consultation/examination, she came up to the front deskI said to her "all procedures are covered with the exception of one item, the pillow because insurance considers it a durable good." The paper she signed is called an "Advance Notice" sheet which is required
by the insurance company for the provider to present to their insured for any services not covered/paid for by the insurance companyThe patient signed the paper with the understanding the pillow would not be covered/paidWhen I said "everything is covered minus the pillow" what I meant was the standard definition of "covered" in insurance languageThis means the insurance company believes the billed procedures are medically necessary and will be paidPayment is considered a multitude of ways by the insurance company; they do this by applying charges to deductibles, co-pays, co-insurances as well as issuing checks/EFT.DrAustin has a contract with ***I do not check patient's benefits (the amount of their deductibles, co-insurance amounts,etc.)when they are insured by *** because I KNOW THE INSURANCE COMPANY WILL NOT DENY THE BILLED PROCEDURESThey will either issue payment via EFT or check to DrAustin or apply the benefits to deductibles, co-pay and co-insurance amountsThat is the definition of "covered."If it wasn't "covered," the insurance company would DENY the services and pay nothingClearly the procedures were covered because the balance due is the patient's deductible and/or co-insuranceThe patient signed up for this insurance plan leaving me confused as to why she thinks she isn't financially responsible for her portion. It is the patients responsibility to know their insurance benefits, what their deductible is, what their co-insurance amount is, etc. After working for DrAustin for years, I only check insurance benefits for patients who have medical insurance in which DrAustin is not a contracted providerI don't have the time to check patient's benefits when they have insurance with a contracted insurance company.Regardless of our relationship with the insurance company, I AM NOT PERMITTED TO WRITE OFF BALANCES THAT ARE THE CO-PAY, CO-INSURANCE, DEDUCTIBLE, ETCIT IS ILLEGAL AND UNETHICALA DOCTOR CANNOT CHARGE THE INSURANCE COMPANY ONE AMOUNT AND THEN TURN AROUND AND CHARGE THE PATIENT NOTHINGTHAT IS CONSIDERED FRAUD
This is not an acceptable business practice and I believe telling a patient "I have checked with your insurance and this pillow is all you need to pay for" could also be considered fraud or at least extreme misguidance. I would never have proceeded with treatment if this statement had not been made to me.
Regards,
[redacted]