Author Topic: Are we able to balance bill an HMO patient if their insurance carriers does not  (Read 2354 times)

Michele

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Question
Hi-
I would like to know as a non-participating physician in Virginia are we able to balance bill an HMO patient if their insurance carriers does not pay the balance in full. Are there any individual insurance companies, such as Aetna, Kaiser, Optimum Choice, that does not allow you to balance bill the HMO patient even when you are a non-par doctor.
Thank You
Chrissy

Answer
Hi Chrissy,
Thank you for your question. It is a good one that we come across quite often.
A non participating provider can balance bill a patient with an HMO as long as the HMO is not a state funded/sponsored product or a Medicaid product. (safety net product)
If the HMO is state funded or a Medicaid product then the provider is limited on what they can bill the patient.
Hope that is helpful.
Thanks
Michele
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