insurance question

[august]

If we are in network with an insurance and we send in a claim and the services are non-covered services the patient should be responsible for the full amount we charge even if we are in-network because it was a non-covered service.   

One insurance that we are in network with will put down the allowable amount for that non-covered service (which is a lesser amount billed.)  Can't we charge the patient the full amount of what we charge because it was a non-covered service?  We don't have to charge the patient the allowable amount that insurance shows on EOB do we?

If we know a service is a non-covered benefit do we have to even send in a claim to the insurance?

[PMRNC]

It depends on the actual contract. You have to pull the contract. If you have a carrier that is putting an "adjustable write off amount" on the EOB, MOST likely your contract only allows you to charge the patient up to that amount (allowable).  But again, the only way to know for certain is to get out the contract.

[august]

Thank you