When purchasing medical supplies or services whose responsibility is it to verify insurance coverage?

Question

I see this often where someone buys an item at a medical supply company and is told it will be covered by insurance. Later, they receive a bill because it was not covered after all. Is it the patient's responsibility to verify coverage with the insurance company prior to purchase or the responsibility of the seller not to falsely represent coverage in the first place?

Answer 1

Its always, always the patient's responsibility... The doctor's office, or medical supplier SHOULD check the benefits. At times, they don't. Ultimately, the patient is the person who is negatively, financially impacted by the lack of verification. So, to be safe the patient should always verify their own insurance information. It keeps us from being taken advantage of by doctor's and medical supplier's. It only benefits you, as a consumer/patient to know your insurance coverage. I work in insurance, and have for 10+ yrs.

Answer 2

The insured.

Any time someone else does it for you, it's a courtesy, and not a guarantee.

It's ABSOLUTELY the patient's responsibility (or in the case of a minor, their parent). The provider can't "falsely represent coverage" as they don't have access to the policy, AT ALL. The insurance company can say they'll pay for something over the phone, but when they get the invoice, they may still deny it (miscommunication or whatever).

Answer 3

It is the responsibilty of the vendor to verify if the insurance is valid, however, all insurance will tell you up front, "Verification of benefits is not a guarantee of payment, actual benefits will be determined when a claim is received" - or some variation of those words. Meaning, when you call the insurance, they can tell you anything you want to hear, but when you bill them they can do whatever they want with it. Either provider or patient can appeal the decision, but if it's not a covered benefit or item, you can't force it to be.