Author Topic: uncovered insurance benefit  (Read 2186 times)

august

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uncovered insurance benefit
« on: November 14, 2012, 07:42:51 PM »
If I would call an insurance carrier to see if a certain service is covered and they tell me that it is non-covered we would tell the patient that and if they still want that service they will have to pay for it.  Since it is a non-covered benefit on their policy will that still go towards their deductible?

Example---Most insurances do not pay for custom made shoe inserts. 

On that note, if something is a non-covered benefit, can we give that patient a discount on that item?  Do we still have to submit to insurance even if we know it is a benefit that will not be covered?


PMRNC

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Re: uncovered insurance benefit
« Reply #1 on: November 15, 2012, 05:53:38 AM »
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If I would call an insurance carrier to see if a certain service is covered and they tell me that it is non-covered we would tell the patient that and if they still want that service they will have to pay for it.  Since it is a non-covered benefit on their policy will that still go towards their deductible?

No, the insurance will only pay their portion of "covered charges". Reimbursement depends on the plan and only if services are covered.

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On that note, if something is a non-covered benefit, can we give that patient a discount on that item?  Do we still have to submit to insurance even if we know it is a benefit that will not be covered?

If you are participating you might just want to check the contract first, but generally speaking you can discount a service but it's best to do do so with a denial from the insurance carrier first. Make sure the bills match in showing charges/discount/payment just to cover yourself.  Some Medicaid carriers may not allow you to bill the patient at all.
Linda Walker
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august

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Re: uncovered insurance benefit
« Reply #2 on: November 15, 2012, 08:08:55 AM »
Thanks for the info!

So it is okay to give a discount on noncovered benefits and that noncovered benefit will not go towards their deductible.  Would the patient have to pay up front for that discount or is it okay to send a bill after we get the denial?

If we are in network with the insurance you suggest sending in a bill showing the original amount charged and the discount that will be given.  If we are not in network do we still need to send in the claim?

I was told by someone in our office that if a service is a noncovered benefit we do not have to send into insurance but was not sure if this was correct or not?