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Needing Clarification PLEASE!

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peaflog4929:
I need clarification...
All patients pay the same discounted out of pocket service, however, the patients with insurance, their insurance company is being charged more then what the patient is charged. If the insurance company doesn't pay we do not go back to the patient with an additional bill.
Ex. Patient Charge $3000(includes services above and beyond that price) this is their discount. Both non-insurance and insurance patients are being charged the same discounted amount.
     Insurance charged $6000(the amount that it would actually cost the patient for the services) insurance pays $3800...the $3000 would go back to the patient, and the provider would keep the rest of the remaining $800.

Just wondering if this is legal?

rdmoore2003:
if I am understanding it right,  no its not legal.
for each cpt code- you should set an amount.  file to insurance then charge patient per eob.
if the patient is getting a discounted rate, you need paperwork to back up why they get a discounted rate.  ex:  pt. does not have insurance and works part time. that information needs to be documented and signed acknowledging understanding by the staff and patient on why patient is getting discounted rate.

peaflog4929:
We are out of network for our services, so we always (whether the patient has insurance or not) recieve payment before the insurance company is billed.
All the cpt code prices never change. The discount is given to each patient insured or not, and is documented.
So, those clients with insurance who where given the discount, there insurance is billed the whole amount, not the discounted rate. Our services for what we provide are almost double the discounted rate.
So again, if the discount is documented (which it is) and all patients are charged the same amount, insured or not, is it legal?
Also, we are never going back to the patient with insurance to collect if the full amount is not paid out by insurance. We eat our loss.
Any patients that have additional charges outside of our discounted package are all charged the same amount for that service...
ex. Patient needs to be tested for a UTI that goes to the lab. This would be outside the discounted package, and insured or not they will be charged. If the patient has insurance that charge will get filed, however all patients still need to pay out of pocket at the time of service because we are out of network.
Additional thoughts appreciated!

rdmoore2003:
 yes as long as its documented, legal

peaflog4929:
So, I have officially gotten it is legal and not legal from the same replier.

Can you clarify why you changed your response from illegal to legal? It is my belief that it is legal, but I want to make sure.

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