General Category > General Questions

Billing Missed Appointment

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camedbill:
One of Dr. bills for missed appointment and eventhough this only gets billed to patient, he is applying an insurance adjustment before billing patient.  He claims that his contract with Blue Cross requires him to apply ppo adjustment on all charges to patient.
Does anybody know if this is true?  I thought missed appointment charges are just separate charges agreed to be paid by patients which has nothing to do with insurance

Michele:
Usually an office will have a policy for missed appointments that includes a set fee.  It isn't usually based on the allowed amount by an insurance carrier.  Policies on missed appointments must be clearly posted.  Some providers use their average office visit charge for the missed appointment but it isn't based on insurance.  BCBS doesn't allow providers to bill for missed appointments (insurance) so I'm not sure why they are going by their contracted rate.

Buglet10:
HI,
In our office we charge a set fee of $50 for missed appts.  No insurance company has a contract regarding missed appt amounts to be charged.  Be careful because some EAPs and insurance like Mass Health which includes the Mass Health portion of Neighborhood Health Plan or Fallon does not allow you to charge for missed appts.  so check that you can charge the client.

PMRNC:

--- Quote ---HI,
In our office we charge a set fee of $50 for missed appts.  No insurance company has a contract regarding missed appt amounts to be charged.  Be careful because some EAPs and insurance like Mass Health which includes the Mass Health portion of Neighborhood Health Plan or Fallon does not allow you to charge for missed appts.  so check that you can charge the client.
--- End quote ---

That's only true if using standard credentialing. However a negotiated contract with carriers CAN EXCLUDE the allowance of allowing patient's to be billed missed appointments. Some will compromise this verbiage by adding they don't want them charged more than the allowable amount. It's more of a "exclusion" of verbiage in the contract and I have negotiated these things out of contracts.

NuBiker:
We bill for the amount we are out due to the missed appointment.
So if the patient's copay is $20, and insurance pays $74, then the patient owes $94.
However, we offer to waive the penalty if the patient can make up the appointment within 10 days after they missed.
Makes for some very long work days, but it is a good compromise.

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