Can I charge the balance?

[jcfenfen]

The physician I'm working for does not have contract with United Health or Blue Cross, when I receive the EOB, it has the "Allowed amount" and has a explanation note that "This is the amount in excess of the allowed expense for a non-participating provider.  The Health Plan is not responsible for any amounts in excess of this allowed expense.  In this case, can I still charge the rest of the balance to the patient? Thank you so much for the help.   

[Michele]

If the provider does not have a contract with (or does not participate) a health plan, then they can charge the amount over the allowed amount to the patient.



Michele

[Michele]

I should have mentioned that the only time that is not the case is if the plan is a state sponsored plan or the patient is eligible for a Medicaid plan.

Michele

[Pay_My_Claims]

Also can't charge if its a Medicare Replacement plan. UHC has Evercare, Secure Horizons, and they follow Medicare guidelines. Being non-par with them we can't bill the balance to the client either.