M
Mikalus
Guest
Who responsiblity is it to send in a claim to a HMO the hospital or the Patient? I know that the design of a HMO is to keep the patient from having to fill out any claim forms and the Providers get the there money quickly. In a case were for some reason it was showing that someone wasnt covered so a medical claim was unpaid for about a year and a half. The hospital tries to collect from patient the patient was unable to get the insurance company to pay she didnt have any evidence coverage. The patient happens to bump into the person who filled out and submitted the insurance application she told her she was covered and called the hospital to show the evidence of her coverage. The insurance company updated there records and the collection company resubmitted the claim. The claim was then denied Not recieved in a timely manner. They will pay the claim if you can show proff of timely filing. My next question is who is liable if the hospital never submitted the claim to the insurance company the patient or the hospital? If the hospital submitted the claim and they can't find the denial which is the proff that they filed the claim in a timely manner who is responsible the hospital or the patent?