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W9 requests Colorado

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by Maxine, Aug 13, 2019.

  1. Maxine

    Maxine Law Topic Starter New Member

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    As a private practice, private pay, health care office with no contracts with any inusurances - do the insurance companies have a right to demand I submit a w9 before they consider claims from my client? They are not paying the money to me - rather to the client. They have no ties to me whatsoever except that my client is also theirs and my client has paid them to cover a covered service which I provide.

    Can they do this or is this another smoke screen to weasel out of re-imbursement.
     
  2. zddoodah

    zddoodah Well-Known Member

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    Anyone is free to "demand" anything from anyone.
     
  3. Tax Counsel

    Tax Counsel Active Member

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    Why does the insurance company have anything to do with you if the patient is filing the claims and getting the reimbursement directly?

    The insurance company can always ask for the W-9. No law against that. The insurance company does not need the W-9 from you, however, if it is not paying you. If it pays the patient directly it is not required to provide a Form 1099-MISC for the services you provided. I suspect that if you submit the claims for the patient, though, the insurance company reps are told to get the W-9 anyway. You may refuse to provide the W-9, but the insurance company might then balk at paying the claims. That may make some patients unhappy. You'll just have to see how it goes if you do that.
     
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  4. army judge

    army judge Super Moderator

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    No, you have no relationship with the insurance company.

    In my view "demanding" your W-9 is a sneaky way for information about you to be passed on to the IRS.

    If you don't fill out a W-9 DULY requested by an employer, partner or other entity DULY entitled to your taxpayer ID information, you may be penalized $50 for each instance.

    You may also be subject to backup withholding, which means the payor will withhold 28 percent of your check and forward the proceeds to the IRS.

    NOTE: You APPEAR to have no direct relationship with the insurance company.
    I don't see UNDER what lawful authority an insurance company UNKNOWN/UNRELATED to you has the legal authority to DEMAND YOUR tax information.

    You might wish to consult your attorney or CPA to see how best to proceed, as either of those entities would have far more information about you to advise you accordingly.

    I'd seek such a consultation prior to doing, releasing, or saying anything about the W-9 "demand".


    You can read more about W-9 forms at: Turbotax What Is IRS Form W-9? - TurboTax Tax Tips & Videos

    OR, what the IRS has to say about the matter:

    About Form W-9 | Internal Revenue Service

    I hope you get this sorted, mate.
     
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  5. Zigner

    Zigner Well-Known Member

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    Did YOUR OFFICE submit the claim, or did your patient submit their own claim?
     
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  6. Maxine

    Maxine Law Topic Starter New Member

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    pt submitting own claims.
     
  7. Maxine

    Maxine Law Topic Starter New Member

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    I have the same question. They have no connection to me, no contract - no contact. They are not paying me at all. They are bulking at paying the claims (submited on a superbill all the info right in front of them ...all CPT codes etc by the client) and I was wondering if they are allowed to that if their contract is with the client. Is there a way to call them to task for this or are they within in their legal rights to refuse to reimburse if I do not give them a W9? This is a very awkard unfair spot
     
  8. hrforme

    hrforme Active Member

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    I have to wonder if they aren't doing so to prove you are a legit business entity and that this isn't the patient trying to defraud them. Unfortunately the insurance has no relationship with you so they have no way of knowing that you are a legit. Possibly offer other information to your clients (receipts that they have paid upfront, etc) who are filing their own claims if you don't want to complete a W-9. - But to me an W9 seems pretty easy to complete as long as they don't send you any 1099s that they paid you directly, there should be no taxable consequences.
     
  9. Tax Counsel

    Tax Counsel Active Member

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    The insurance company doesn't need the Form W-9 from you because it is not paying you. You aren't even submitting the claims — the patient is apparently doing that. You may need to work your way up a little higher in insurance company food chain and explain that they are not required to get the W-9 from you because you have nothing to do with the insurance claims. Chances are that the lower level administrative people have been told they need to get it from all providers. That's a simple rule that is easy for them to apply. And 99% of the time, they would have to do that. You need someone at the insurance company who can overrule what policy they have on this at the moment.

    Other than doing that, there isn't much you can do. The insurance company has a contract with your patient and you aren't involved in the claims process. It is up to the patient to read the contract and challenge the insurer if it refuses to pay a claim over this issue. The chances are pretty good the contract does not allow the insurer to deny payment because of this.

    By the way, while Army Judge speculated that this was a sneaky attempt to provide information to the IRS, it is very likely not that. The Form W-9 is not provided to the IRS unless the IRS expressly asks for it in an examination (audit) of the insurance company's returns. And there won't be any Forms 1099 for the insurer to issue to you because the insurance company has not paid you anything. What this almost certainly is, and I see it a lot, is a large company adopting a one size fits all policy to ensure its butt is covered should the company get audited (and the largest U.S. companies get audited a lot). They don't want to rely on their employees to have to understand the tax rule and apply their brain cells to make a good decision. So they give their workforce a simple rule to follow instead. Better to get a Form W-9 when it is not needed than to fail to obtain one when it is.
     
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  10. PayrollHRGuy

    PayrollHRGuy Active Member

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    If they refuse to reimburse that really is an issue between the insurance company and their insured. But I fully understand that you want your patients taken care of. The only thing on the W9 that is something you don't want everyone in the world to have access to is your EIN, though it isn't a big deal. I would just complete the W9 for them.

    Remember insurance companies are big, bureaucracies. There is nothing you can do that they would feel in the slightest and your client's claims would get paid.
     
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