Can I bill the patient after a denial? (Honest guardrails.)
Whether you can bill the patient after a denial depends entirely on the denial reason and your contract — some denials shift balance to the patient, but many contractually cannot be billed to them. The bright line: a CO (contractual) adjustment is your write-off and generally can't be billed to the patient, while a PR (patient responsibility) amount can.
What actually matters
- Read the group code: PR (patient responsibility) may be billed to the patient; CO (contractual obligation) is your write-off and generally may not
- Denials for provider errors — no auth you should have obtained, untimely filing, coding mistakes — usually can't be shifted to the patient under your contract
- Non-covered services can often be billed to the patient, but only if they were properly informed in advance (e.g. an ABN for Medicare)
- Balance-billing rules and the No Surprises Act further restrict what you can bill in certain out-of-network and emergency situations
- Billing a patient for a contractual write-off can breach your payer contract — check before you send the statement
Common questions
Can I bill a patient if the insurance denies for no prior authorization?
Usually not, if obtaining the auth was your responsibility — that's typically a contractual write-off, not patient responsibility. Shifting a provider-side error to the patient can violate your payer contract. Appeal or write it off rather than bill the patient.
How do I know if a denied balance is patient responsibility?
Look at the group code on the remittance. PR means patient responsibility and can be billed; CO means contractual obligation and generally can't. The reason code and your contract together determine it — not just whether the insurer paid.
Where Volari fits: Many denials that get billed to the patient are actually payer errors the practice could have recovered — Volari works those on the insurer side, so the balance doesn't get wrongly shifted to the patient or written off.
See the revenue you're owed but never collected.
A free assessment shows your real recoverable number from denied and underpaid claims. No risk, paid only on what we recover.