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Medicare, Medicaid, Life and Health Insurance/Can a practice keep the co-pay collected for claims denied d/o untimely filing?

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Question
Our practice uses an outside billing source and we have several claims that were denied over the years due to untimely filing, they claim to have appealed the denial and the appeals were overturned and the denials were upheld.  Now our billing company is asking us to refund the co-pay collected from the patients for these dates of service, some of them going back to 2007.  It makes no sense as we did the work and collected the co-pay in good faith. Can we keep the co-pay if a claim is denied due to untimely filing?

Answer
Hi Sue!

It would depend if you have a contract with the insurance companies.  When they deny a claim they will tell you on the EOB if you can bill the patient for anything and most of the time you can not under a contract.

Most copays are based on what the insurance company is paying and if they are not most of the time you can not bill the patient.

However on non contractual payments you may be able to but again you would have to look at the EOB to determine that.

At the medical company I work for going on 24 years most of our insurance companies we are contracted with and we do not charge patient for the copay on any claim denied for untimely filing.  The EOB for these claims clearly state we can not.

Good Luck!
Tricia

Medicare, Medicaid, Life and Health Insurance

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Tricia

Expertise

Has your medical insurance company denied your claim and refuses to pay? Have you received a pre-authorization and still your insurance company refuses to pay? How can you get your insurance company to reverse a denied claim? How do you get a provider to waive your copayment if you are financially unable to pay? Can a provider sue you for a unpaid bill and will they? Can a provider send me to a collection agency for a medical bill? If my insurance company does not pay, am I responsible? If you have these questions or others on why your insurance company is not paying your bills, I can help. I can give you "tricks of the trade" to get your insurance company to pay. I have limited knowledge on Medicare and Medicaid and that is not my expertise. Each state is very different regarding Medicare and Medicaid so you need to review their website when you have questions. So please no Medicare or Medicaid questions!!

Experience

In the medical field for over 20 years spending majority of time in the collections aspect.

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