Can a health care provider use a patient's signed consent with another provider to bill a health care insurance for services?

Asked 8 months ago - Fresno, CA

A local hospital routinely has patients sign a consent to bill their insurance company.

There is an entity that has clinicians assigned to the hospital to provider specific services. The clinicians assigned to that hospital seldom get the patient to sign the entity's own consent form to bill the insurance. And the question is if this entity can use the patient's signed hospital consent to be able to bill for the entity's services.

Not sure, but something like California's Welfare and Institutions Code 5832(C) could allow that kind of arrangement? Please comment.

Attorney answers (4)

  1. Richard Todd Rosenstein

    Contributor Level 19

    3

    Lawyers agree

    Answered . This is a common practice. If you go to the emergency room at a hospital for treatment, the patient may be billed by the hospital and by each medical practitioner that provides services to the patient in connection with the emergency room visit. You may also be billed separately by the radiologist and by other test related facilities.

  2. Christopher John Gansen

    Pro

    Contributor Level 18

    3

    Lawyers agree

    Answered . Probably best to tell us what happened and why you need an answer to this question. As worded, the answer is "often yes, but not always, depending." All the best.

  3. Ryan Michael Davidson

    Pro

    Contributor Level 15

    4

    Lawyers agree

    Answered . This one really could go either way. The form you sign may actually authorize them to do it they way they're doing it.

    Also, I think you may not have the right code section. But even if you did, that's the kind of specific legal advice that isn't appropriate for this forum. If you have general questions about insurance forms, that's one thing, but specific information about the application of specific laws to specific facts is going to require an office visit.

    This answer does not constitute legal advice and does not establish an attorney-client relationship.
  4. David Barrus Baxter Jr.

    Contributor Level 4

    3

    Lawyers agree

    Answered . From a HIPAA perspective, the provider does not need your permission to bill your insurance. Your personal information can be used for what is referred to in short as "TPO," which is "Treatment, Payment, and Healthcare Operations. I am not licensed in California, so I cannot opine on California State law.

    Some private insurance agreements with providers require this consent. I really don't know why, but they do (it may be a state insurance regulation). So, I would make sure that the provider agreement does not address it. Also, some government payors require an assignment of benefits, so that may come in to play also.

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