Medical Billing Forum

Payments => Insurance Payments => Topic started by: marley on June 14, 2011, 09:01:52 PM

Title: out of network insurance
Post by: marley on June 14, 2011, 09:01:52 PM
i was always taught ? Is there ever a write off involved. I was always taught no.

billed 1950.00 insurance paid a portion and say remaining is

patient's deductible 250.00, coinsurance 35.00 say 70/30 plan remaining balance due from patient is
1665.00 ( no writeoff at all ) or do we just charge them their out of network benefits ?

let me know if i am wrong.

we have had alot of patient's call and say why the large bill


Title: Re: out of network insurance
Post by: PMRNC on June 15, 2011, 07:05:59 AM
From your example it looks like this is a non managed care plan and is an indemnity (coinsurance and Deductible) so no the amount due would be billed to the patient. When they call I guess you just explain to them this is their out of pocket expenses as per their insurance plan.
Title: Re: out of network insurance
Post by: tlewis on June 22, 2011, 04:23:36 PM
Can you post exactly what the insurance EOB says?
Is the doctor concerned about the high cost to the patient?
There is a couple of ligit ways to lower the patient balance on out of network plans.
1. don't charge the patient for the amount above "usual and customary"
2. Some insurance companies will send out of network claims to a third party payment negotiator and this will reduce the cost for the patient.

One of the insurance companies we are not in network with will send claims to a negotiate a lessor cost. I have a standard formula that I use  for all claims. If they don't automatically due this you can call the network and see if they will. You don't have to agree to the terms they send you and you can negotiate the price. At first they would send pricing well below what would be accepted. However, I called them and stated what the "policy" for the company was to accept and if they sent a price adjustment for less than that I would not accept the reduction. Now the claims all come back with agreed upon amount.

sometimes it is like playing car salesman

Disclaimer. NEVER write off the patients deductable or co-pay amount. This amount is what the patient has contracted with the insurance company as their obligation and you are in violation if you write off that portion of the patients amount due.