Hello!
I'm billing for a mental health provider based in WI. We have a client with a commercial policy that has a large deductible. The provider has asked me to bill the service at the regular $150 rate, but wants to only charge the client $80 with the intention of writing off the rest, due to financial hardship. Clearly this is fraudulent and I won't be able to do this, but I still have some of questions...
1. Can the provider bill the insurance $80 for now (so that it will still go toward the deductible accumulation), and then once the deductible is met, go back to her regular rate of $150? The provider is contracted with this insurance company, so I suspect the answer to this is a sound NO. Or maybe it depends on what the contract says??
2. Can the provider see this client on a cash basis for $80 for now (not billing insurance anything), and then when the deductible is met, charge the regular $150 rate and start billing to insurance? Assuming that a signed financial agreement outlining this would have to be in place, especially since the provider is contracted with the insurance company.
I don't want to put either my business or the provider at risk by doing anything fraudulent or shady, but I also want to see if there are any options for providers when they are trying to help a client out in this type of situation. I'm sure this is a question that I should already know the answer to, but hoping that someone can fill me in, and possibly offer some advice for an alternative way (if there is one) to handle fee discounts due to financial hardship.
Thanks so much!