We are set up for direct billing to a number of insurance companies.Here are some of the common problems we encounter:
1) The patient is not signed up for direct billing –> they will have to pay and manually submit.
2) The patient’s plan number does not allow direct billing –> they will have to pay and manually submit.
3) The claim is declined (this is because the patient has no more coverage, does not have coverage for this service, or has not met the prerequisites) –> the patient will have to pay.
4) The claim is submitted for further processing (this means that the computer was not able to process the request and requires a manual response. It usually takes 3-7 days for us to receive a response from the insurance company) –> we will call the patient if the insurance company denies the claim or does not pay the full amount.
5) The insurance company does not pay the full amount, for whatever reason –> the patient will be required to pay the remainder.