Author Topic: Patient Discounts with Contracted Insurance Companies  (Read 1071 times)

platmedrec1

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Patient Discounts with Contracted Insurance Companies
« on: February 22, 2011, 11:06:02 AM »
This is a questions one of my docs sent to me today:

"If a patient has insurance with a company that we are contracted with but doesn't want us to file their insurance then we can't file is that right? We could just give them the discount and file nothing? "

My gut says if we are contracted than we have to submit the claims, but then I start doubting myself.  Because what if they never presented with an insurance card?  They have insurance that we are contracted with, but we were unaware of the insurance. 

Is this ok to do?


rdmoore2003

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Re: Patient Discounts with Contracted Insurance Companies
« Reply #1 on: February 22, 2011, 02:53:26 PM »
My understanding of this question is, a patient has every right to decide if they use their insurance benefits or not.   However, you must be very careful and may want to have a form that states that patient is not wanting to use insurance and have them sign, because at a later date, they may file to insurance themselves and that can then stir up the pot.
Regina

PMRNC

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Re: Patient Discounts with Contracted Insurance Companies
« Reply #2 on: February 22, 2011, 04:13:03 PM »
You also cannot DISCOUNT unless that discount is SHOWN on the bill the patient receives and that is in case they file.  I generally discourage my providers from doing this..especially when it is a carrier they do participate with! They cannot receive any discounts, not even the adjustment because they are going OUTSIDE their contract (both patient and provider)
Linda Walker
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midwifebiller

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Re: Patient Discounts with Contracted Insurance Companies
« Reply #3 on: February 22, 2011, 10:56:42 PM »
I do all of our family's insurance billing.  I've had too many coding and billing errors happen and then there is a mess to clean up and fall-out with the billing department, doctor, etc. I pay upfront, then submit the claims myself.  Never had a doctor question or complain.

Kelli Sugihara, CPMB
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PMRNC

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Re: Patient Discounts with Contracted Insurance Companies
« Reply #4 on: February 23, 2011, 09:04:17 AM »
Quote
I do all of our family's insurance billing.  I've had too many coding and billing errors happen and then there is a mess to clean up and fall-out with the billing department, doctor, etc. I pay upfront, then submit the claims myself.  Never had a doctor question or complain.

I do too, but I don't have a PPO. Most physician's managed care plan's have clauses in their contract. So with that I'll just say the provider is responsible for checking his/her contracts.  A cash practice that is doing this w/out any contracts is fine. It's only the plans in which they participate with that they should check their plan contracts.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com