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Medical Coding and Billing: How to Deal with Patients on Insurance Payments

Patients with whom you interact with as a medical biller or coder may not fully understand how insurance works, so you may be called upon to explain some insurance basics. These situation often arises when the insurance company sends a payment to the patient instead of the provider by mistake, when a patient receives an explanation of benefits (EOB) statement he doesn’t understand, or when the patient receives a bill from the provider.

Many such situations arise when patients are out-of-network and, as a result, are often responsible for a large portion of the bill themselves. In these situations, the following suggestions can help you resolve the issue:

  • Before making any calls, make sure you know what the provider’s policy is regarding out-of-network patients. If the provider is knowingly treating patients outside of the network, a policy should be in place to address how these claims will be handled.

  • If the patient receives a check from the insurance company by mistake, it may be your responsibility to call the patient and explain that they need to surrender the check to the provider. An alternative is to inform the patient of the situation and then bill them for the full charges, explaining that they can use the insurance check to pay the bill.

  • Unfortunately, some patients refuse to surrender the check. In that case, collection agencies get involved or lawsuits are filed.

  • Inform patients of payment plan options. When additional payment is expected of the patient, explain any payment plans that are available, including credit cards or financing options accepted by the provider.

  • Always be cordial, even when patients may get angry and direct their anger toward you. Don’t allow yourself to be drawn into an argument. Try to remember that the patient’s frustration isn’t personal. Keep your comments friendly and professional, and you’ll do right by your employer or client.

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