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Discounting a Non-Covered Service to a pt that has insurance

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krudolph:
We are a specialty practice and are Anthem Providers.  Many of our patients that have Anthem do not have coverage for office visits.  We submit the claims to the insurance company and get back EOB's indicating the allowed fee (our contracted rate with Anthem) as what to charge the patient.  If you print the patients benefits it reads "Professional Ofiice Visit In Network - Co-Insurance 100%-does not contribute to out of pocket"  Because it does not contribute to their copay/deduct/out-of-pocket can we discount this fee even further based upon our sliding scale policy and be legally correct?

PMRNC:
I have no idea what that means? They have NO coverage? Is this for all patients? Was there something specific denied?

krudolph:
Sorry, let me clarify.  The patients do have coverage thru Anthem and we are a participating provider; however, their policy does not cover office visits and the patient is responsible for 100% but because we are contracted with Anthem we have agreed to accept the allowed fee and not charge the patient our full fee.  My question is because it is not a covered benefit and the pt portion does not go towards deduct or the patient's out of pocket expenses can we give the patient a prompt pay discount if we do this for all Anthem patients that have the same situation?  Basically the only benefit the patient has with Anthem on Office Visits if going to an in-network provider is it will be adjusted down to the Anthem allowed amount.

Pay_My_Claims:
i'm confused too. I would think that even if par, if it's a non-covered benefit, the allowed would be 0, and it would all drop to patient responsibility. I would contact Anthem for clarity as to why they have an allowed for a non allowed charge.

PMRNC:
Yes.. What charlene said!.. but I'm still stuck as to why they don't have coverage for office visits? Is their coverage just for hospitalization ?  ???

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