You really don't say what exactly was billed. If you billed $575 and did NOT show the discount, that's a big no no.Did the patient complete any type of financial hardship agreement? If not that's another mistakeEither way, the patient is responsible for all deductibles and coinsurance as it is the "COST sharing" provision of their policy. This is quite a pickle because if YOU AGAIN waive deductible it's wrong.. If you violate whatever agreement you had with the patient it's another problem. I think if this was something "I" billed out, and I made no agreement with the patient in writing (financial hardship) I would REBILL the claim correctly using the correct charge amount and showing the $150.00 payment and then speak with the patient and it would still be ok to discount the out - of - pocket as long as their is some sort of financial hardship agreement signed and noted in patient's chart. JMO
i'm confused....did you bill out 575, and the ins company only allowed 105.00?? if this is the case and you are a contracted provider, then yes you owe the client all but what she should have paid for the deductible. Nothing else matters. the way i read it, patient says she has not met deductible, procedure is 575 provider charge. provider says to client ok, i will bill your ins, and charge you 150 plus what they pay. and waive the balance. you bill case 575, but ins company only allows 105. and paid 70 30 goes to deductible. had not the hardship factor been involved, client would have only paid the 30....who verified the benefits and checked on her deductible status??? We must remember, no matter what we bill, contracted providers can only bill patients what is allowed. if the agreement wasn't made. the provider would have to refund the patient. if she collected it up front (client not met ded), once the ins pays, and it only allowed 105, provider must refund.
Yes billed as normal. Fee of $575. EOB information below:Billed= 575.00 Allowed = 105.30Applied to deductible = 0.00Co-Ins = 31.59Paid = 73.71Adjust Amt = 469.70Patient Balance = 31.59
My thoughts exactly but now the saga continues. The office now wants to re-bill (send a corrected claim) to the insurance carrier at the discounted amount. Still no confirmation on a hardship agreement (written) with the patient. I've requested a copy for my records.