Payments > Insurance Payments

Varying U & C for OON claims?

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Pay_My_Claims:

--- Quote from: PMRNC on May 19, 2009, 10:32:03 AM ---You didn't indicate what the "disallowed" was. If it was denied for U&C, and you have confirmed that the claim was processed as "NON" par then you can bill the patient for any amounts over U&C. You could also appeal the claim or have the patient appeal it, either way it is appealed, most likely the doctor will need to send in something so it's just easier to appeal then and there rather than try and collect from the patient and then they will need the info to do the appeal.You however are in the right if you should bill the patient, just keep in mind most won't pay those fees until they have exhausted appeals.  :'(

I would also think you might want to check par status with the carrier, for non par they don't usually use the word "Contracted Rate" on a non par EOB... and disallowed would have an explanation as to why it was disallowed in the remarks area.



--- End quote ---

I can send you EOB's with the names & policy numbers etc blackened out we ALWAYS get billed with the term "contracted" rated and disallowed is what we billed minus the allowed amount. If we charged over U&C and they denied for that, yes we could appeal that as to be able to bill the client, but we have never had that happen.

PMRNC:
You don't have to appeal to bill the patient. The appeal is just a courtesy. You can bill the patient for anything over U&C.

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