Billing > Billing

Question about Patients Sending Claim to Insurance

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PMRNC:
We are just not used to seeing it, but she said the patient wants to now send the bill. The practice probably has an across the board rule not accept or file claims..again that's not common but we are starting to see it more frequently as doctors move away from insurance. It takes a special office to run this type of practice and they have to be in the right location and have maintained a steady stream of loyal patients. But really there's nothing wrong with it. Maybe this patient wasn't aware of their insurance and paid in full and later realized the services would be covered..
Maybe their benefits were reinstated.  But again, the bills have to MATCH.

Pay_My_Claims:
OK, then question. Client pays for visit, as a cash discount. Provider is par with the insurance. Provider gives patient cash discount. He said 97001 150.00 (his fee schedule). Cash discount 80.00 and she pays 70.00. What if the allowed amount on that charge is 60.00??  and they are a network provider??

PMRNC:


--- Quote ---OK, then question. Client pays for visit, as a cash discount. Provider is par with the insurance. Provider gives patient cash discount. He said 97001 150.00 (his fee schedule). Cash discount 80.00 and she pays 70.00. What if the allowed amount on that charge is 60.00??  and they are a network provider??
--- End quote ---

you missed this post before my last one  :D



--- Quote ---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.
--- End quote ---

Example of acceptable cash pay :

patient has Aetna PPO. Provider is NON par with Aetna. Provider normally charges $100 for 99213
He discounts the patient $20.00. Patient wants to file their own insurance (or office doesn't file for non par) Doctor gives bill to patient but the bill needs to be printed to either show full charge and break out the discount OR show the discounted fee.

DOS                        CPT                     DX                Charge          PMT       Adj             Balance

8/1/09                  99213                   250.00                $100.00         $80.00    $20.00            $0.00

OR


DOS                        CPT                     DX                Charge                PMT                   Balance

8/1/09                      99213                   250.00             $80.00                $80.00                    $0.00

Pay_My_Claims:
No, I understood your reply, I asked the poster why did the client not pay when they had insurance. I am not just going to ASSUME that they are non-par. Your replies to the post was as if they are non-par. I want to know if they are par, what are they going to do in regards to her filing her own claim!!

This is why I am asking the question because if they are par, and the payment she made isMORE than the allowable..... what??

PMRNC:
I doubt this is non par, I took the question to mean the patient paid cash was maybe unsure of reimbursement and then decided to just give it a shot. Their question was just pertaining to the bill they need to give the patient which I think is common sense that it needs to match.. all the other stuff is just assumption...I've had patients say "oh we don't have insurance, then they pay cash and then later they want to submit to insurance, the carrier will still pay in most cases par or non and if there is no assignment they will reimburse the patient, occasionally in that situation the carrier will send the money to the provider. I just had a situation where my benefits were changed and I didn't get the new card or info for a visit I had to my family doctor on 8/1, I just paid him cash, when I got the card I gave it to the OM and she filed the claim for me and I got the check 2 days ago, I paid the office cash, I got a check and on the EOB they billed what they charged me so it all worked out. And they were par, we just didn't know the carrier at the time of the visit. Par providers SHOULD file the claims but there are certain circumstances they can't. If the carrier were to reject or deny the claim a simple call would have cleared it up.

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