Author Topic: Deductible  (Read 3073 times)

ruthie72

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Deductible
« on: February 19, 2013, 06:26:50 PM »
I am so confused..I am new at this..My question is..when a patient has no copay, and they say that want to pay X amount towards their deductible..when I do the claim do I put what they paid on the claim? OR how does the insurance company know what they paid?? HELP   ???

PMRNC

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Re: Deductible
« Reply #1 on: February 20, 2013, 12:43:24 PM »
Any payment they make is entered with the claim. It's not advisable to collect MORE than each visit. Deductible's are calculated by the carrier on a first come first serve basis, so if you collect for example $100 towards 2013 deductible but other providers or the patient had other claims sent in, the first $100 in patient out of pocket is going to go towards the deductible. I always advise my clients to just take the copay/coinsurance amount. It cuts down on the refund's later.
Linda Walker
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ruthie72

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Re: Deductible
« Reply #2 on: February 21, 2013, 07:16:54 AM »
Thank you so much. If what the insurance company pays the provider is $62 and the patient keeps paying $65 each time, then the patient is going to have a $3 credit each time is that correct? I am wondering if I should just tell my provider to have her not pay towards the deductible and just bill her the $62$. I do not think she has a copay...what do you think?

PMRNC

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Re: Deductible
« Reply #3 on: February 21, 2013, 10:08:45 AM »
From your example, it's just not really clear. I don't know if the provider is participating, if there is a par adjustment. Benefits for all my clients are verified either through myself or the office staff and normally we just try to collect copay/coinsurance to keep the credit balances at a minimum.

Another way you can approach it is to have patient pay in full with NO assignment of benefits. When patient meets their deductible, have them bring in the EOB to show it's been satisfied.   Again, though I'm going on the premise that this is a non par carrier indemnity plan with coinsurance/deductible. The rules change if it's a carrier your provider contracts with.
Linda Walker
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ruthie72

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Re: Deductible
« Reply #4 on: February 21, 2013, 11:35:45 AM »
Yes my provider is a PAR...

PMRNC

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Re: Deductible
« Reply #5 on: February 21, 2013, 12:40:57 PM »
OHHHH wait.. I think I got ya now ;)

 
Quote
If what the insurance company pays the provider is $62 and the patient keeps paying $65 each time, then the patient is going to have a $3 credit each time is that correct? I am wondering if I should just tell my provider to have her not pay towards the deductible and just bill her the $62$. I do not think she has a copay
...

If the carrier is PAYING $62 a week (I don't know billed amount though) MOST likely there is no deductible, OR it has been satisfied. You have to look at the EOB because you will also have a participating provider adjustment unless you are billing the allowed amount.  IF this is a participating plan, then technically you should NOT be collecting that much from the patient.  But without knowing HOW much was billed, how much was allowed, I can't say for sure.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
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ruthie72

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Re: Deductible
« Reply #6 on: February 21, 2013, 07:23:04 PM »
I will try to make myself a little more clear (I am totally confused so bear with me). Okay So the provider's fee is $75 always..the allowed amount that the insurance company pays is $62. The patient has been paying the provider $65 each time she has been in because she says she has to pay it towards her deductible, (why she thinks this, I am unsure). So..now when I go to do the claim, how do I treat this? Thank you..I really hope this makes sense.

PMRNC

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Re: Deductible
« Reply #7 on: February 22, 2013, 07:03:57 AM »
So the carrier is allowing 62 and paying 100% of the allowable ($62)?  If so then she has NO out of pocket. If the $62 is a payment of another "allowable" the patient would owe the difference. For example if the carrier allowed $70, and paid $62 your adjustment is $5 and patient is responsible for $8 per visit.
Linda Walker
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ruthie72

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Re: Deductible
« Reply #8 on: February 22, 2013, 08:56:47 AM »
that make sense, thank you..what if she does have an OOP? Then what would the patient be responsible for. Sorry I am asking so many questions. Thank you so much.

PMRNC

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Re: Deductible
« Reply #9 on: February 22, 2013, 11:17:14 AM »
Quote
that make sense, thank you..what if she does have an OOP? Then what would the patient be responsible for. Sorry I am asking so many questions. Thank you so much.

Well if the provider is participating with the carrier then usually the EOB will tell you the patient responsibility which is normally the difference between the allowable and the paid.  about 95% of all EOB's have this right on it so you know what to bill the patient and what is adjusted off.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

ruthie72

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Re: Deductible
« Reply #10 on: February 22, 2013, 02:42:47 PM »
Thank you Linda  :)