Patient Financial Responsibility Quotations
A home infusion pharmacy quotes patient financial responsibility in writing prior to the start of IV therapy. After billing, the pharmacy learns that the patient responsibility is different (less or greater) than what was quoted. Is the pharmacy bound by the written quote, or does the payer have the final say about the patient's financial responsibility, as per plan requirements?
Teresa C. Floit, A/R Quality Assurance Coordinator, VNA Home Care Services
Response Summary
There were 2 Listserv responses to Teresa’s question. In summary, the payer will determine the final claim amount based upon the patients plan. Any quotation should be stated as an estimate of charges and even with prior approval authorization that this is not a guarantee of coverage and payment.
Rock-Pond Analysis
To assure your best opportunity to receive payment for services rendered, you should always advise the patient and/or legal guardian of their insurance coverage as well as inform the patient of their ESTIMATED financial responsibility for services PRIOR to the start of care. It is good business practice to assure that all deductibles, co-pays or out-of-pocket expenses are collected prior to services being rendered. Involving the patient in the financial responsibility discussion at start of care will save a business many dollars in subsequent expenses.
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