Billing > Billing

Billing question

<< < (2/2)

Steve Verno CMBS, CEMCS:
Is this an HMO under State law jurisdiction with no patient balance billing law.

Example:  Florida Statute 641.3154 prohibits balance billing patient.  You can appeal but if they do nothing, your doctor might be able to go to court but may lose because HMO may say what they paid is all they have to pay.

What does the patient benefit manual state the insurance has to pay?
Example:  benefit manual may say the benefit is to be paid at 100% of out of pocket expenses.  It could also say they pay 60% of their UCR and patient pays balance.

Is this an ERISA plan?
Example:  Per 29 CFR 2560-503-1, the benefit payment appeal must be done by the patient within 180 days of the date of the adverse benefit determination. The appeal is per the insurance company appeals process outlined in the patient summary plan description.

DavidZ:
Got it
thanks

Navigation

[0] Message Index

[*] Previous page