Bernadette Posted Mon 15th of July, 2013 19:35:05 PM
We would like to know when an insurance company denies a procedure and states "denied- not a covered benefit", should we stipulate that the member be billed for this procedure? Should they indicate that the member is to billed or not billed with this denial? For instance, patient came in for a well visit and had the visual acuity screen done. We bill a CPT code
99173 with an IDC-9 code
V20.2and the insurance denies it as not a covered benefit, but does not say "do not bill member" or "member may be billed".
We thank you for your response ...
SuperCoder Answered Mon 15th of July, 2013 22:15:43 PM
Are you asking whether the insurer should stipulate on the EOB whether or not the member should be billed for the balance? Not all insurers stipulate that, but if you know up front that it won't be covered, ask the patient's parents to sign an ABN agreeing to pay. Either way, however, unless your contract says otherwise, you can usually bill the patient for the non-covered service once the insurer denies it.