Author Topic: OON Balance Billing  (Read 1942 times)

pvtbiller

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OON Balance Billing
« on: June 11, 2012, 02:23:50 PM »
If you are an out of network provider do you have to bill the patient or can you just accept what the insurance pays and write off the balance?

PMRNC

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Re: OON Balance Billing
« Reply #1 on: June 11, 2012, 04:18:20 PM »
Provider's may not routinely waive out of pocket, in network or out it makes no difference. If it's done routinely and without documentation of hardship it is considered fraud. Also the patient is in violation of their policies which contain cost sharing clauses. (copay's, deductibles, coinsurance).   So short answer is NO they need to make attempt to collect OR obtain financial hardship documentation according to their office policy.   A provider MAY give a discount but ONLY if that discount is shown on the claim.. and yes that's right, it means the patient still doesn't get away with not paying. If you have $100 claim and the patient's copay is $25.00 but the provider wants to discount that co-pay, he/she does so but the money comes out of their portion and patient is still responsible for their cost-sharing of the claim.  NOT showing the discount is fraud.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
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