Author Topic: HAVE NO CONTRACT WITH THIS INSURANCE  (Read 1185 times)

ellie

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HAVE NO CONTRACT WITH THIS INSURANCE
« on: June 16, 2010, 06:42:23 PM »
billed amount is say 5200.00 
eob breakdown
in total charges column
766.89
non ppo reduced 4433.11
total billed charges= 5200.00

column ppo discount 4177.49 non coverd patient liability 255.62

total payment 766.89

benefits quoted 75% of billed charges = 3900.00

6000.00 out of network deductible

pt paid $ 1300.00 at time of service
i billed the patient remaining 3133.11
patient says i was wrong in billing this

HELP  !!!!!!!!!!!!!! 

is there such a thing as non-ppo reduced ?????????? eob states which has been applied to the covered out of network charges



Michele

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Re: HAVE NO CONTRACT WITH THIS INSURANCE
« Reply #1 on: June 16, 2010, 07:55:44 PM »
If the provider is non par it really doesn't matter what the eob says.  Charges are $5200, pt pd $1300, ins pd $766.89 so the balance is $3133.11
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NuBiker

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Re: HAVE NO CONTRACT WITH THIS INSURANCE
« Reply #2 on: June 25, 2010, 07:29:06 PM »
Ellie,
Whenever I get a new patient and am verifying eligibility, I always include a disclaimer saying that when I tell them what their copay is going to be, it is only my best guess. I also give them a "worst case" scenario (sp?), telling them that what they will have to pay officially is determined when I recieve the EOB (Explanation Of Benefits), usually around three weeks later.
Kind of like that disclaimer you hear the isurance companies use when you phone them.
Does anyone else here do that?
Nu