Payments > Insurance Payments
Out of network billing
wharta:
She has worked out with anthem what they will pay her, so since she does not have a contract, she should not accept assignment and balance bill? But if she does not accept assignment they probablyown't pay her, and if she does accept assignment she is to take what they pay as final payment and cannot balance bill- correct?
PMRNC:
It's still unclear because on one hand you said she's NON contracted..if they "negotiated fees" for that person ok, I understand..(usually they don't but ok ???) If that's a negotiated fee for all her patients with Anthem..then she is contracted..I don't understand why they wouldn't have contract? Are you POSITIVE there is no contract? maybe they are telling you what they will pay at the NON contracted rate? Even Still BCBS is not going to honor assignment for a non contracted provider, the patient is going to get the check.
Also Michele is right..if the provider is agreeing to "accept assignment" she's agreeing to that fee as payment in full you can't balance bill the patient! you need to call provider relations and find out if there's a contract or not.
Michele:
Balance Bill = bill the patient for whatever amount is indicated on the eob to be patient responsibility. (unless provider is non par, then balance bill would be any remaining balance after insurance payment)
wharta:
Right, I believe she was referring to what they will pay at the non network rate, because she has no id number or anything from anthem. She set her fee schedule according to this amount also. So I should set her up as not accepting assignment, and balance bill remaining from the allowed amount?
I think that is correct :)
Pay_My_Claims:
--- Quote from: PMRNC on August 19, 2010, 12:27:24 PM ---It's still unclear because on one hand you said she's NON contracted..if they "negotiated fees" for that person ok, I understand..(usually they don't but ok ???) If that's a negotiated fee for all her patients with Anthem..then she is contracted..I don't understand why they wouldn't have contract? Are you POSITIVE there is no contract? maybe they are telling you what they will pay at the NON contracted rate? Even Still BCBS is not going to honor assignment for a non contracted provider, the patient is going to get the check.
Also Michele is right..if the provider is agreeing to "accept assignment" she's agreeing to that fee as payment in full you can't balance bill the patient! you need to call provider relations and find out if there's a contract or not.
--- End quote ---
We file BCBS assigned all the time, it really doesn't matter because BCBS does not send non par providers the check. Non-assigned would mean the payment needs to go to the client because they paid up front, so you have nothing else to choose but assigned. BCBS just does not honor that they expect you to collect up front knowing their policy. They want to get patients to go to par providers and this is a way they do it. You can still balance bill the patient for everything after payment. BCBS pays according to contract, but since you are non-par, you have the RIGHT to balance bill. Accept assignment rules would apply more to medicare than commercial payors
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