Medical Billing Forum

General Category => General Questions => Topic started by: maxamillion125 on January 01, 2014, 08:34:27 PM

Title: Plastic Surgery
Post by: maxamillion125 on January 01, 2014, 08:34:27 PM
Do most plastic surgeons accept Insurance rates and adjust the rest off?  If they have a patient financial policy that says the patient must pay the remainder of the charges after Insurance pays, regardless of what they allow does it supersede the Insurances EOB?  Are practices allowed to do that?

Example patient A
$2700 charge for tumor removal
Insurance paid $650, patient copay is $125, the rest is adjusted off
If the plastic surgery had a patient financial policy in place that said the patient had to pay the remaining balance of the original $2700 (-650 Insurance.)  Is that legal? 
Title: Re: Plastic Surgery
Post by: Christy on January 02, 2014, 02:15:53 PM
If the doctor participates in the insurance plan, he or she cannot charge more than the patient responsibility indicated on the eob...

If the doctor is out of network, he or she is entitled to the entire fee.
Title: Re: Plastic Surgery
Post by: maxamillion125 on January 08, 2014, 08:55:29 PM
So if the plastic surgeon wants to opt out of all Insurance plans, therefore he's out of network then we can bill the patient for the full amount charged?
Is this what most plastic surgeons do?  Does anyone have a patient financial policy I can sample?
Title: Re: Plastic Surgery
Post by: Michele on January 11, 2014, 08:12:04 AM
I don't think we can say that All or Most plastic surgeons opt to not participate so that they can collect their full fee.  There are some that do and some that don't.  There are many plastic surgeons that participate with most insurances and accept their fees in full.  There are also those that are more of a private pay plastic surgeon and they are out of network with most or all insurance plans.  It is important that patients check into this prior to having any services done.  If they don't mind paying out of pocket then they can choose who they want but if money is an issue they should make sure that they pick an in network plastic surgeon. 

If an in network plastic surgeon tries to charge above the allowed amount then the patient would need to contact the insurance carrier.  They usually deal with the providers directly. 

Are you looking for a financial policy for an out of network physician?
Title: Re: Plastic Surgery
Post by: Merry on February 10, 2014, 09:06:31 PM
I am going to comment on this old post because it may have been a bit confusing. Many people do not realize that a plastic surgeon does much more than cosmetic surgery. I think, as Michele and Christy pointed out, is that it has nothing to do with the physician's specialty but whether the physician is in network. Sometimes the idea of a plastic surgeon can muddy up the waters.