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Question about Patients Sending Claim to Insurance

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lbd122:
Hello Everyone,

I have a patient who paid our cash rates.  She would like to send in a claim to her insurance now to see if anything will get covered (i.e. if they will get reimbursed for any of the bill).  So she would like me to send her the bill with the necessary information.  Here is my question:

Our billed charges differ from our cash rates.  So in the bill i create for her should her payments be reflected?  or Should I just leave it as the patient is being billed the entire billed charge amount? 

Sorry if this is hard to understand...here is an example (do I do A or B):

     Date       Description                        Charges          Insurance Pending       Payments/Adjustments        Patient Balance

A  8/25/09    Initial Evaluation (97001)      150.00                 0.00                              0.00                            150.00

B  8/25/09    Initial Evaluation (97001)      150.00                 0.00                              80.00                             70.00


Thank you!

PMRNC:
That bill should be for whatever you charged her, it should not be different at all as that would be fraud.
If you billed her $150 and your normal rate is $200 and she paid $150 you don't want to give her a bill for $200 because she'll end up getting reimbursed more than she paid!  ???

The bill needs to match and if she has coinsurance or deductible that will get deducted as well.

Pay_My_Claims:
Why would she pay cash if she has insurance. Why didn't you just bill a non-assigned claim??  Are you a contracted provider with the insurance???

PMRNC:
There's nothing wrong with providers that take cash and have the patients file their own insurance AS LONG as they don't participate with that plan and as long as they are giving valid receipts/billings so that when this situation arises the patient has a bill for services rendered and paid to submit to their insurance company and they MATCH. You can't bill the patient one fee and the carrier another. 

Pay_My_Claims:
Exactly, we do it often since we are non-par providers, but we generally file the claim for the client. I just want to know why she wants to file after paying her "discounted" cash rate???  Something smells to me.

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