Contracted = Allowed AmountNon Contracted = U&C or R&C
I was referring to United Healthcare, we are not contracted however for all the PPO policies the U & C amount has been varying. I understand we can bill the patient, however I am unsure as to why the insurance wouldn't have the same U & C amount for the same CPT code when both patients have a PPO policy...
It can vary based upon the employer. It could be a self insured group plan.
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.