Collecting from an out-of-state patient

April 18, 2008

I recently provided care for a patient visiting from another state. He filed an out-of-network claim for my services, but his insurer refused to pay, and he hasn't responded to the bill I sent him. What should I do?

I recently provided care for a patient visiting from another state. He filed an out-of-network claim for my services, but his insurer refused to pay, and he hasn't responded to the bill I sent him. What should I do?

In this case, the patient is responsible for the bill. Most managed care contracts require patients to call for instructions before securing out-of-state care, or within, say, 72 hours of receiving emergency treatment.

Notify the patient that you expect payment for your services. Give him a detailed statement to present to his insurer or employer if he wants to appeal the denial of his claim. If he balks, send the account to an agency that handles interstate collections.

The answer to our reader's question was provided by H. Christopher Zaenger, CHBC, Z Management Group, Barrington, IL.

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