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If a medical claim is denied because the provider did not file in time is the patient responsible for payment?
Wiki User
∙ 8y ago
Check out this page where Medicare talks about providers being responsible for billing errors if it's their fault
http://www.cms.hhs.gov/manuals/13_int/a3700.asp
CA Civil Code # 3517. No one can take advantage of his own wrong.
3520. No one should suffer by the act of another.
3526. No man is responsible for that which no man can control.
3529. That which ought to have been done is to be regarded as done, in favor of him to whom, and against him from whom, performance is due.
3533. The law disregards trifles.
I would say no. I'm looking though for the documentation. Here's what I have so far....
Q52. How do my PPO benefits work?
A52. We have established a network of "Participating Providers". These providers are called "participating" because they have agreed to participate in our preferred provider organization program (PPO). . Receiving services from the Blue Cross PPO Provider network can substantially reduce your out-of-pocket costs. These lower costs are due to negotiated rates that Blue Cross PPO Providers have agreed to accept. These providers SHOULD file claims to Blue Cross for our members, then bill you for the remaining portion of their eligible charges. http://www.bluecrossca.com/pdf/faq/sg_member_faqs_ppo_plans_123002.pdf
For more info see www.SteveShorr.com
I checked with upper management at Blue Cross - here's their answer
Claims submitted by Participating providers after their contractual timely filing period are denied as a provider discount amount. The member is not responsible for these services.
There may be instances where a provider does bill the patient for this denial in error. When this occurs, the patient should either contact the provider and remind them this is a provider discount based on the EOB they received from Blue Cross or contact us directly and advise the provider is attempting to bill the member. In the later situation, we will then work with the provider to resolve the matter.
No the patient can not be responsible . It should be the providers writeoff.
Wiki User
∙ 8y ago
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If a medical claim is denied because the provider made billing errors is the patient responsible for payment?
The patient is responsible for the cost of all medical care.
If a patient does not inform us he has medicaid is he responsible for the bill?
In Illinois, if the provider did not accept the patient as a Medicaid patient, the provider may bill the patient.
What does medical receivables refer to?
Medical account receivables refers to the department that is responsible for collecting payments from the patient's insurance provider, without this department, the patient would have to pay the bills and then get reimbursements from their insurance company.
Who is responsible for medical bills after a patient is deceased?
the patient's next of kin
What is deductible in medical billing?
deductible mean patient should pay pearticular amount to the provider, before provider start treting the patient.
How long does a medical provider have to bill a patient?
A medical provider does not have to bill a patient if they don't want to. They can bill any time in the future and add interest and other penalties. They can also refuse you service.
Who is the person responsible for paying the charges for services rendered by the provider?
the patient himself
What individual is responsible for communicating with medical providers?
patient
When can a medical provider write off or give a courtesy discount to a patient with no funds?
That's entirely up to the provider.
What is a medical record?
Documentation of services provided by a health care provider to a patient
Who are the three participants in the medical insurance relationship?
Provider, Patient, and Health plan
Who is responsible for paying medical bill's the patient or the person under who's insurance they are covered?
patient
