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You are the Medical Administrative Assistant for your practice. The phone rings and you answer it. It is Mr. Wilson, a patient of the practice. He is very upset because he received an EOB (explanation of benefits) in the mail today indicating the insurance denied his claim for his most recent office visit because it was not considered medically necessary. Your practice has not yet billed Mr. Wilson, but he warns “You better not even think about billing me for that visit, or I’ll sue you”. Mr. Wilson does not want to hear that the office can appeal the denial if he is willing to complete the form that was sent to him. He adds “paperwork is your job, not mine!”

If you were in this situation what would you do?
Think about and incorporate applicable PRICE (Professionalism, Respect, Integrity, Caring, and Engagement) characteristics.

Should you alert the physician or office manager or try to handle on your own?

Should this incident be documented in the patient’s medical record? Why or why not?

Please answer all questions completely. APA format must be used.

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