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.
Quote from: PMRNC on May 22, 2010, 05:37:15 PMNo, 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. thats not true. I have it on my EOB's all the time. I verify benefits every day. I can fax you over one of mines so it wont' be a violation. They will state billed 110, allowed 110, paid 0, and the denial is non covered benefit. This allows you to bill the patient. BCBS pays for Office Visits, but lets say my plan doesn't cover that. Does this mean BCBS does not have an allowable or fee schedule??
Yes, you can definitely bill the patient, but you can bill them up to the physicians fee, A carrier cannot "allow" something, deny it as NON covered and expect the doctor to only collect what they WOULD have allowed? The doctor should be able to collect THEIR full fee. I have a few clients with BCBS private insurance and some of the high yield deductible plans only cover diagnostic testing, no office visits and the allowable shows $0