Author Topic: Collecting ded/copay/coin. for OON patients-Legal???  (Read 1698 times)


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Collecting ded/copay/coin. for OON patients-Legal???
« on: June 15, 2010, 05:38:38 PM »
Good Morning All-

I have a small billing service with clients all over the US.  I'm hoping the answer to this question can be relayed to all my clients, no matter where they are.  This question is referring to a provider that is giving or wanting to give patients a "discount" or collect " in network" (even though they are not and obviously don't have a contract with the insurance provider). 

Example:  United Healthcare patient comes in and has services which are billed out at $200.  Since the provider is OON, the provider wants to charge the patient the 10% IN NETWORK fee for services and write off the extra 20% (OON coinsurance is at 30%). 

Is it legal to do this??  What about if the patient has a HIGH OON deductible and the provider wants to collect IN NETWORK deductible.  After the IN NETWORK deductible is met, the patient just pays coinsurance even though that amount is still going towards their OON deductible.  UGH....sounds so confusing.  Hope someone can enlighten us!!!
Thanks Guys!!
Pam McKewen