Author Topic: client wants to pay direct to psychologist  (Read 8094 times)

kwardbilling

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client wants to pay direct to psychologist
« on: November 13, 2012, 09:24:26 AM »
Hi, I have a quick question.  I have a new provider that is just beginning with me.  She has stated that a client would like to pay her, the psychologist directly, and have insurance reimburse her instead.  She has CIGNA.  We are in Massachusetts.  Can you tell me if this is ok to do, also, the counselor is not credentialed with CIGNA.  Can she only charge what insurance reimburses?

thanks for any information you may have for me.

Michele

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Re: client wants to pay direct to psychologist
« Reply #1 on: November 13, 2012, 09:42:34 AM »
If she is not in network with Cigna than yes she can do that.  She can also charge her regular rates.
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rdmoore2003

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Re: client wants to pay direct to psychologist
« Reply #2 on: November 13, 2012, 09:43:54 AM »
if the psychologist is not networked with the insurance, then she will charge pt the cost of whatever code is used and then can give the patient the information so that pt can file to her insurance.   if a pt chooses not to use insurance, that is their choice.
Regina

kwardbilling

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Re: client wants to pay direct to psychologist
« Reply #3 on: November 13, 2012, 09:53:23 AM »
Thanks for the quick response.  If the counselor was credentialed with CIGNA, could they still do the direct pay?  Also, if that were the case I would imagine that she could only charge the cost that insurance would pay?  Thanks again.

rdmoore2003

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Re: client wants to pay direct to psychologist
« Reply #4 on: November 13, 2012, 11:23:12 AM »
that is correct.
Regina

PMRNC

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Re: client wants to pay direct to psychologist
« Reply #5 on: November 13, 2012, 01:06:17 PM »
NO. Regardless of whether the provider is Par or not, they still must adhere to the cost sharing provisions of the patients policy. For example if the doctor NORMALLY charges $100 a visit, but they want to discount, they must show the discount but it will make NO difference to the carrier, they will pay based on the plans policy.   For example, if the provider wants to accept only $80.00 that's fine, but he will still need to bill to the insurance company and either bill the $80 or show the $100 charge with the $20 discount. Either way, the carrier is only going to cover THEIR portion of their U&C (non par) or allowable (par).  It is considered fraud to waive out of pocket copay's and coinsurance/deductibles. Whether a provider is par or not is of no exception.
« Last Edit: November 13, 2012, 01:07:58 PM by PMRNC »
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rdmoore2003

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Re: client wants to pay direct to psychologist
« Reply #6 on: November 13, 2012, 02:11:04 PM »
that is correct -post meant that it was correct that if provider is contracted that they can only charge the patient the insurance rate.  maybe i should have explained better.   if provider is contracted with insurance they must: if they charge $100 for visit but contract says pt has deductible of $300.00-the patient must pay their deductible before the insurance pays.  visit is 100.00, pt has 300.00 ded, contract allows 42.00 for the 100.00 charge, you can only charge the 42.00 to the pt.  that would leave 258.00 to deductible....

sorry I didnt explain better.
Regina

kwardbilling

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Re: client wants to pay direct to psychologist
« Reply #7 on: November 13, 2012, 06:14:05 PM »
Thanks, i do understand about adhering to the cost sharing provisions set forth by insurance policy, my question is more about if the patient can pay provider direct and submit for reimbursement herself. The provider hasn't suggested discounting. So example provider charges $100 for session, patient pays provider, patient submits to insurance company, insurance pays patient allowable amount. Does that make sense and sound correct? Again provider is not contracted with CIGNA. Thanks again for all of your responses.

PMRNC

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Re: client wants to pay direct to psychologist
« Reply #8 on: November 14, 2012, 11:13:58 AM »
Quote
Thanks, i do understand about adhering to the cost sharing provisions set forth by insurance policy, my question is more about if the patient can pay provider direct and submit for reimbursement herself. The provider hasn't suggested discounting. So example provider charges $100 for session, patient pays provider, patient submits to insurance company, insurance pays patient allowable amount. Does that make sense and sound correct? Again provider is not contracted with CIGNA. Thanks again for all of your responses.

Yes patient can pay in full. Just make sure the itemized bill reflects the FULL charge and full payment. I've seen doctors "collect" the discounted amount, give patient an itemized bill to submit and the bill includes full charge w/out mention of the discount. That is fraud. The bills have to match all the way around. If the provider discounts the charge it needs to be shown as such.
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