I have a aba provider that i am working for now, who is out of network with bcbs. However she was getting the out of network rate and with the Lumenos plans that her pts have, they are supposed to pay a 40% coinsurance and almost double the deductible. On her past claims they never did, she only charges the allowed amount ( which is her fee schedule also).
We are worried that now that since we have looked up this info because she was bringing on a new pt and we learned about the coins and ded for oon, that those will apply and she will eventually loose her business, because if a pt sees you for 40 hrs@ 18.75 per 15 min, that would be $3000 and coinsurance would cause the pt to pay $1200 per week, and they would go to a in network provider.
Should we submit the new claims and see what happens, does her only chargeing the allowed amount have anything to do with it?
Please help!