If a patient pays out of pocket, can the provider bill the insurance for the service?

Free Insurance Comparison

secured lock Secured with SHA-256 Encryption

Asked March 25, 2015

1 Answer

The short answer to the title question is, yes, the provider can bill the insurance if the patient pays out of pocket. That said, it is best to check with your own insurance company to be sure of the laws in your own state. With few exceptions (such as Medigap policies) there is no comprehensive federal law governing the insurance industry. Each state enacts its own insurance laws. Therefore, what is legal in one state may not be in another. The laws in all states will say that neither the provider nor the patient may collect twice from the same policy for any single service. If double payment is received, the provider must return overpayments.

Patients with double insurance, that is policies provided by two different companies, may collect from each one for the same service, but the total amount paid may not exceed the total amount charged by the provider for a particular service. In these cases, the secondary insurance pays whatever amount the primary policy did not pay, including deductibles. Usually, the two companies will coordinate these payments between themselves.

More complicated questions include whether or not the provider will agree to send an invoice once he has received payment, and can you be sure to get your cash payment back if he does?

Insurance companies keep accurate records of bills received, whether from providers or from insured persons, usually filed according to date of service. If a provider’s bill is the first one received for a service, it will be paid, if it is eligible for coverage. If the patient then attempts to collect, his claim will be rejected. When a patient pays out of pocket, the insurance company has no way to know about it unless payment is reflected in the provider’s statement, or unless the patient notifies the insurance company that he has paid out of pocket.

Patients usually receive statements from the insurance company showing all claims paid on their behalf. If a provider has received both a cash payment and an insurance check, the patient should immediately request a refund from the provider. The provider may not apply an insurance payment to unrelated amounts owed by the patient, nor may he collect twice for the same service. He must return the excess amount immediately.

Again, the short answer is, yes, the provider can send a courtesy billing to the insurance company for the patient, but overpayments must be returned to the patient who paid out of pocket. Whether he will do so or not is most likely a matter of the provider’s own office policies. The patient may be considered responsible for collecting his own insurance claim by sending a copy of his billing.

Answered April 9, 2015 by Anonymous

Related Links

Free Insurance Comparison

Compare quotes from the top insurance companies and save!

secured lock Secured with SHA-256 Encryption