Has anyone else had a patient with a third party administering the patient’s Work Comp Medicare set-aside account, and the funds became exhausted, and your office was not notified? This company actually issued an EOB, but never funded the amount allowed on the EOB.

The additional issue here is the patient’s private insurance requires an authorization for services. Naturally, we did not have an auth for the private insurance because we did not know the set-aside account had been exhausted.

Wondering what the protocol is for the balance? Could the patient be billed? Is it patient responsibility to let us know if funds are exhausted?

Insight is appreciated!