Payments > Insurance Payments

OON provider reimbursement

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midwifebiller:
Thank you for your input! All said, we have had good results by having the member work with their HR department for higher reimbursement. Since these are non-par, non-solicited providers (they won't contract with us even if we wanted to), HR will usually work with their members and then the carriers for the better reimbursement rates. I was just hoping there was an easier way, but it doesn't sound like it.  Thanks again!

~Kelli

PMRNC:
No, when you are non-par and you decide to appeal U&C you are actually doing it as a "courtesy" to the patient since they are typically getting a bill for the balance. (should be anyway)
With Surgical charges that have been cut for U&C you usually would send an op report with your first appeal along with a letter. In many cases the carrier will then issue another payment so it's always worth "a shot". Sometimes the patient is good for a second appeal since it is technically them appealing the claim cut back.

Linda Walker
PMRNC
www.billerswebsite.com

midwifebiller:
Linda--Yes, everything we do is courtesy to the patient, but it helps our midwives with their businesses. Especially as the economy gets tighter, more people are wanting their insurance to cover midwifery care (most do) at the in-network rate (this is the tricky part) or at least a 'good' rate. We have not tried appealing the U&C after reimbursement; that might be easier than trying to obtain in-network exceptions, HR exceptions, etc., before submitting the claim.

Thanks again for your input!

~Kelli

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