Insurance Advice

[CF Ins Person]

What is the name of your state? TN
We bill extracts for allergy shots that are made up specifically for patients to take their shots with our office or mail them to an outside office to be given. We have pt. sign notices stating they understand that a serum is made especially for them and they are financially responsible for this extract (which can cost up to $1000) even if the regimen is not continued or finished, because the medicine is already made. A lot of people seem to think that they are not liable for this medicine. The make-up of the form is simple and in laymen's terms and everyone is given a copy after signing for their records. If they contact us before the prospective date of making (they are informed of that date), we can halt the medicine being made. It never fails though for many of them to be shocked when they either receive the bill or when their ins company pays for the extract. We have had some of them call the ins company to recoup the money from us stating that they did not receive the service. We have had to send the signed statement from them stating that they requested this service to them and to ins. I am just making sure that we are within our legal rights to bill the ins for these requested services even if the patient refuses to return or if there is a law book i can look for this in. I once had a lady the ins paid in full, call ins and they recouped the money from her and we had to in turn sue her to get paid. That was silly seeing that the ins had already paid for it, then after that she came and started taking the shots anyhow. Just asking cause it occurs so often.
Thanks CF

 

[CIAA]

I will leave your legal question to others and just make an observation. That is, based on the frequency of the problem, it certainly seems that someone would want to revise the methods of disclosure and explanation to these patients. While I know that some will still not get it, it just sounds as if a lot could be done in the way of better disclosure.

 

[CF Ins Person]

I don't understand

okay what other disclosure, the doctor explains, then they come out to us, we explain, we have them sign, we give them copies, dates, and also a schedule of the treatment, what other disclosure do i need, what am i lacking.

CF

 

[CIAA]

CF, it may be my misunderstanding of the way your work flows; but I can't really accept that a good solution can't be found to the frequency of such a problem.

It sounds like the disclosure about being billed sometime in the future is lumped in with a lot of other "records", "treatment schedules" and other "disclosures".

I don't know, but if you required payment at the time the order is placed, I suspect they would know. This may require you to do refunds or make credits if you let them cancel within x days, or some modification of your cancellation policy.....but again, I'm not familiar with the actual process.