Author Topic: Network Participation & Billing  (Read 223 times)

Chiro Billing Collect

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Network Participation & Billing
« on: July 12, 2017, 08:16:09 AM »
If a provider is participating, are they REQUIRED to bill the patient's insurance? If they choose not to, are they then allowed to charge the patient a higher rate than the plan's fee schedule and not send the claims in?

Thank you.

Michele

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Re: Network Participation & Billing
« Reply #1 on: July 12, 2017, 08:37:22 AM »
If the provider is participating then their contract with the insurance carrier will state what they are required to do.  In my experience, most contracts state that the provider MUST submit the claim for any services provided to the patient AND that they CANNOT charge them a higher rate than the contract.  If they want to be able to not submit the claim and charge more than the allowed amount then they should consider being non participating. 
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PMRNC

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Re: Network Participation & Billing
« Reply #2 on: July 13, 2017, 07:52:07 AM »
The exception would be if the patient does NOT want their bills submitted. Patients have a right not to have their bills submitted, some may even submit their own. The contract is between the provider and the carrier but the patient can decide not to have it submitted. Many do this thinking they can get the cash discount from the patient sparing them their out of pocket. IF a patient chooses to file their own insurance I would have them sign a waiver that explains that they are choosing not to have the provider submit the claim. If a cash payment discount is applied the patient should get a bill that reflects the actual charges as per the contract and the discount should be shown as well as any payment the patient made and w/out an assignment of benefits.

Linda Walker
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