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Insurance reimbursement

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carnilent:
If a patient pays for medical service as Self pay     can he submit a claim to his insurance carrier in order to get reimbursed of the fees he paid for the medical service?  if so,  will the insurance reimburse at 100%? or at a lesser amount and how long can a patient wait before submitting a claim to insurance for reimbursement?

DMK:
The patient can submit a claim to his insurance company if he paid cash.  He will need a statement from the doctor's office with all the correct coding to submit the claim.

The insurance is still only obligated to pay the allowed amount.  Some policies have no out-of-network benefit so they would pay nothing. If there is out-of-network benefit the patient's deductibles and co-pays still apply

So if the service was $100, he went to an out-of-network provider and paid $100, the insurance would pay the out-of-network amount less any deductibles and co-pays.  That could be calculated on U&C amounts, or allowed amounts.  And this will vary from insurance to insurance.

Michele:
The insurance carriers each have timely filing limits as to how long a patient has to submit a claim.

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