A patient arrives for a scheduled appointment and presents an insurance card that includes a specified $20 co-pay for specialist visits. However, the patient states that they have met their annual out-of-pocket maximum and should not be charged. What is the appropriate action for the medical assistant to take?
Do not charge the co-pay and allow the patient to see the specialist, taking the patient's word at face value.
Refuse service unless the co-pay is paid upfront regardless of the patient's out-of-pocket expenses for the year.
Insist the patient pays the co-pay as indicated on the insurance card, disregarding the patient's claim.
Verify the patient's insurance benefits to determine if the co-pay is required.
The correct action is to verify the patient's insurance benefits to confirm whether the annual out-of-pocket maximum has indeed been met. If so, the co-pay would not be required. Simply accepting the patient's word without verification could lead to improper billing procedures. Charging the co-pay without verification might result in an overpayment and unnecessary administrative work to issue a refund. Denying the patient service based on non-payment of the co-pay without verification could breach the patient-practitioner agreement and potentially result in patient dissatisfaction or a formal complaint.
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