Payments > Patient Billing

Discounting patient responsibility for non par insurances

(1/3) > >>

paulette:
Is is acceptable to discount the amount we bill a patient when his/her plan is out of network as long as we have a set discount or set flat fee for all patients?  For example - we receive $0 - EOB states patient owes $600 - can we discount patient balance to $400?  It only makes sense that the non par insurance carriers can not dictate what we actually accept from the patient.  Are there any known state laws that would govern this practice?

Michele:
Technically you are not supposed to charge a patient a lower amount than you charged the insurance carrier, even if you are not in network.  They can't dictate what you can charge, but you are not supposed to charge different amounts.  There are a couple of reasons behind it.  For example, if the patient has a deductible and you bill the insurance $600, they apply the whole $600 to the patient's deductible, and then you only charge $400.  But $600 was applied to the deductible. 

If you are going to accept less than you submitted to the insurance carrier then you need to document the patient's chart as to why.

Michele

Pay_My_Claims:
I don't view it as charging less, but I wouldn't just offer up a discount either. Being non-par only means that you can balance bill the patient. You don't have to, but if you choose to you can. You can adjust off whats considered non-allowed by the carrier and bill the client that. EX: Non-par provider bills 600.00 for his services. EOB reads Charge:600.00 Allowed 400.00 ded: 400.00  Pt respons: 600.00 Paid to provider: 0.00
It shows that the patient is responsible for the 600 because although we billed 600.00 the ins company only allowed 400.00 and his deductible was 500.00 Even if we were par the bill would be his, and all he would technically be responsible for is 400.00.  I think charging less would be if a client comes in with insurance and we bill them 600.00 v/s him coming in with none and we charge 400.00 w/o the balance after you bill the insurance in my opinion is called an adjustment. As long as you accept what the in network reimbursement would have been, I can't see that as illegal.

Michele:
I should have been more specific.  What I was referring to was charging the patient less than the allowed amount by the insurance carrier, even if you are non par.  So the example would be:

Charged insurance:   $600.00

Insurance allowed:    $500.00

Applied to deductible: $500.00

Only bill patient:        $400.00


Of course you can choose to only bill the patient the allowed amount even if you are non par. 

Hope I didn't cause any confusion.

Michele

Pay_My_Claims:
Exactly............we see eye to eye on it too.

Navigation

[0] Message Index

[#] Next page