Billing > Billing

Question about no OV coverage

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jwangelin:
When a pt has no OV coverage, can you charge the pt the allowable amt from the insurance company, or do you have to charge the pt the full charge as in what you would charge the insurance company if they had OV coverage.   ???

Michele:
I'm confused, if they have no coverage for OV's, why is there an allowed amount?

PMRNC:
There are quite  few private plans or high deductible yield plans that don't cover office visits. But Yeah I agree with your question.. how can their be an allowable?

Pay_My_Claims:
if you are in network with BCBS and one plan allows 125.00 for an OV, but your BCBS does not cover OV, then you can have an allowable. It will be adjusted as non-allowed benefit. Just because its not an allowed benefit does not mean its not an allowable. It will then become patient responsibility.

PMRNC:
No, when something is considered a "NON" Covered benefit, there is no allowable. The allowable would be "0"
My sister has a quirky plan where she has tests and such covered but NO office visit coverage, I'm in middle of an appeal for her for something else but her EOB's show the allowable as 0 for office visits.  "Allowable" means allowable. Now it could be that they don't cover "routine" office visits with a diagnosis criteria in which case the allowable would be what they would "allow" if it were a covered diagnosis under their plan.

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