I need to know so that out of network clients that are responsible for say 30% get charged correctly, I like to charge accurate fees and not just fly by like some billers that I have met around the country.
If you are out of network, doesn't the payment go directly to the patient, and you just charge your regular fee schedule? The patient has to pay the whole thing right?Michele
BCBS will not honor assignment of benefits. A few states have taken them on in court over this and lost.
Well .. actually I have never had a problem with it. Any of my clients that don't par I have them collect up front.In EVERY SINGLE BCBS Policy Handbook and EVERY PROVIDER Contract.. they state this.. so it should never be a surprise, if the doctor is NON par with BCBS..the patient SHOULD be aware and the doctor should be prepared to collect up front. They also have an automated disclaimer when you verify benefits.
Your high billing providers should par with BCBS it makes more sense to par than not. Your avg family practices and smaller practices have more practical choices to Not Par. In some cases a large dollar billing provider will be LOSING money NOT participating. On my consulting clients I run reports based on a 2 year period to determine gains and loss with par/non par carriers and almost always the larger practices are losing revenue from being non par with some carriers. There's not many con's for them NOT to par.