LAS VEGAS (KTNV) — Jason Harris and his wife are upset after learning they had a credit for $679 with Women's Health Associates of Southern Nevada.
They only found out after the birth of their second child.
The couple had their baby in August of 2015. Their baby was delivered by a doctor who works for WHASN - a network of gynecologist and obstetricians.
Then in 2017, Jason's wife was pregnant again but this time when he went to pay for the doctor's bill with WHASN he received unexpected news.
"The lady said I had a credit for $679 and I said why hasn't anyone told me," Harris said.
For three years, Jason didn't know he had a credit with the company and now he's warning new parents to beware and always double check to see if you have unclaimed money.
WHASN provided the following statement:
Women’s Health Associates of Southern Nevada (WHASN) practices insurance and patient billing policies and procedures that are in line with other local and national medical service providers. WHASN is proactive about educating patients about their eligibility and benefits.
As with other medical service providers, WHASN requires co-pays, co-insurance, and deductibles to be paid prior to services being rendered. Patients who are being seen for obstetrical or surgical services are provided an estimated patient responsibility based on information provided by the insurance company. Patients scheduled for a surgical service are required to pay their estimated portion prior to their pre-operative appointment. Obstetrical patients are permitted to make payments for their estimated financial responsibility over a period of time, with the total amount due by the 28th week of gestation.
Once the medical service has been completed, a claim is submitted to the insurance company for adjudication. The patient will receive an explanation of benefits (EOB), once the claim has been processed. The EOB provides detailed information for the patient, including name of provider, date of service, services billed, amount billed, amount paid by insurance, amount applied to patient deductible, amount applied to patient co-insurance, amount applied to patient copay, total patient responsibility, and date the claim was processed. This information is provided a few days in advance of the physician receiving payment for the services provided to allow the patient to dispute the charges, if needed. This also provides the information necessary for the patient to determine if they overpaid or underpaid the provider.
Once WHASN receives the payment and EOB, the payment is posted to the patient’s account. It is at this time that any contractual adjustments are applied to the billed charges and the patient’s portion is transferred to the patient responsibility. The patient prepaid credit is then applied to the patient’s responsibility.
In most instances the patient’s account will have a balance or a credit after the insurance payments and patient payments have been applied to the charges. This is a result of the claims adjudication for the multiple medical services providers submitting claims for the surgery or delivery. It is impossible to know, prior to the claims adjudication, which provider will absorb the deductible and at what point the patient will reach their out-of-pocket maximum. If the patient has a balance, statements will be sent showing what the balance is. The patient can then pay the balance in-full or make monthly payments.
Patient credits are usually addressed at the patient’s first appointment following payment of the claim. Once the credit is discussed with the patient and their address information is verified, a refund request is submitted to the corporate office for processing. In most cases the patient receives the refund in 30 days. However, there are times when a credit fails to be identified and the credit remains on the patient’s account for an extended period of time. This is usually due to the patient not following-up with the provider after surgery or delivery, the patient’s claim not being adjudicated promptly, or the claim is pending adjudication by the secondary or tertiary insurance. WHASN providers delivered more than 12,000 babies in 2018. With the large number of pre-pay credits for patients scheduled for surgeries or deliveries, it can sometimes be difficult to identify every account with a credit not associated with a surgery or delivery scheduled in the future. In any event, any patient credit remains on the account until refunded to the patient.