Insurance Under Payment and Contractual Allowance Review
Each account will be reviewed to determine if the insurance company has made payment in accordance with its contract with the hospital. For accounts where payment is not correct, RTR will contact the insurance company to obtain the deficiency amount. If payment is correct, we will advise the hospital accordingly, so that the account can be adjusted correctly in the hospital’s records. During this process RTR will not contact the patient, unless the hospital requests us to do so.
If the insurance carrier does not respond to follow-up efforts, RTR will advise the hospital accordingly. At the hospital’s direction RTR will either: (1) send a letter to the patient advising him/her of this fact and requesting that he/she contact his/her insurance company; (2) review the account with RTR’s retained litigation counsel to determine the legal alternatives available to the hospital against the insurance company; or (3) discontinue our collection efforts and return the account to the hospital.
If after our collection efforts have been successful and a patient liability still remains due (i.e. co-insurance, deductible, private room charges, etc.), at the hospital’s direction RTR will either: (1) transfer the account to our self-pay department to contact the patient and explain that a balance is due and attempt to collect same; or (2) discontinue collection efforts and return the account the hospital.