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Ann Posted Tue 23rd of January, 2018 12:09:14 PM
Hello, a patient comes in for Mirena IUD insertion and device and presented with Tricare information. We received authorization from Tricare and we inserted the device. Tricare later retracts the money stating patient has primary coverage. After contacting the patient, we find that her mother had coverage (even though the mother states she was unaware that her employer signed her up for coverage). This insurance is an HMO product and since we did not have an authorization (and they don't accept retro-requests), they denied. We billed Tricare as secondary with primary denial in hopes of payment (since we had an auth), however, they denied as primary denied. Who is responsible? Can we bill the patient for these services?
SuperCoder Answered Wed 24th of January, 2018 03:16:53 AM

Greetings from SuperCoder!

 

It seems that the patient did not provide you the correct information regarding the insurance. Now in case of denial from both Tricare and HMO, it becomes the responsibility of the patient to pay the charges for these services.

 

Please feel free to write if you have any question.

 

Thanks.

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