Payer Responsibility

March 1, 2006

I just finished reading the panel discussion, "Collect More Money," which appeared in the July/August 2002 issue of Physicians Practice. There was one discussion about patients signing waivers, making them responsible for payment if their insurance does not pay for a specific service. We also use the waiver forms in our office, but as soon as patients receive bills from us for uncovered services, they call their insurance carrier and are told they are not responsible for payment because their physician belongs to their plan. I was wondering if you have heard of this happening in other practices and how they handle this situation.

Question: I just finished reading the panel discussion, "Collect More Money," which appeared in the July/August 2002 issue of Physicians Practice. There was one discussion about patients signing waivers, making them responsible for payment if their insurance does not pay for a specific service. We also use the waiver forms in our office, but as soon as patients receive bills from us for uncovered services, they call their insurance carrier and are told they are not responsible for payment because their physician belongs to their plan. I was wondering if you have heard of this happening in other practices and how they handle this situation.

Answer: The answer depends very much on your agreement with each plan you accept.

Some contracts say that anything you do can only be billed to them, and if they reject it, too bad. Others allow you to bill patients for uncovered services - flu shots, Botox injections, etc.

You'll have to look at each and every contract.

Of course, even then you may need to remind your payers of the terms of their own agreement. Their customer service reps might not understand the rules.

Good luck.