Author Topic: What are the legalities of adjusting the patient bill?  (Read 1582 times)

Alice Scott

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What are the legalities of adjusting the patient bill?
« on: March 02, 2008, 06:59:51 AM »
Question
I am very new to medical billing. When I get an EOB which doesn't pay, but applies the amount to the patient's deductible, what are the legalities of adjusting that bill for the patient? We charge a lower amount for cash patients, so the person who has insurance would be paying us more in this case. Is it legal to adjust this amount or do we need to charge the amount that the insurance applied to their deductible?
Thanks,
Kelly W.

Answer
Hi Kelly,
Legally, a provider must bill a patient for any amount applied to his/her deductible and copay. It is usually spelled out in the providerís contract with the insurance company. If an insurance company gets word that a provider is not billing patientís for their deductibles, they can terminate the providerís contract. However, there are some ways around it. Laws vary from state to state so I canít speak for certain where you are located, but a provider can offer a discount if there is Ďfinancial hardshipí. Michele
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