by dtanner » Tue Nov 30, 2010 08:01 pm
I have a physical therapy claim - the patient has a deductible due, she paid it. But there is no payment from the insurance company - is the balance a complete write off after the adjustment charge is taken off?
Posted: Mon Jan 03, 2011 01:36 pm Post Subject:
What kinda adjustment charges are you talking about?
Once the deductible is met the insurance company should have no reason not to meet the claim. Did the claimant demand an explanation? Also, ask her to go through the terms and conditions of her policy.
Posted: Mon Jan 03, 2011 07:41 pm Post Subject:
If you have a contract with an HMO/PPO, then the portion exceeding the deductible or the patient's copay is compensable according to your contract with the HMO/PPO. If your charge is limited by the contract, then you are essentially unable to bill for the "adjusted" amount.
If the patient's insurance does not cover your claim at all, then the patient is responsible for the balance. You can discuss the matter with the insurer's claims department.
Did you receive an "Explanation of Benefits" from the insurer detailing the way the claim was handled? You should have received some sort of documentation from them.
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