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Mental Health Billing

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Angie:
Linda can you explain the "problem" please?
We do know the insurance will only pay their allowed amount; which we don't know what that is because we are OON; my question was if had to collect the difference of the billed amount and allowed amount from the patient or if we could write that off and the member only pays what was applied toward their deductible, copay, coinsurance per the EOB.
Does that make sense? We are just trying to help this particular family that is in a very unique situation.....

PMRNC:
I did explain in a previous post. In an OON scenario, the insured STILL has a contractual obligation of "cost sharing" which means they MUST pay ANY out of pocket expenses.. PERIOD. When that plan pays THEIR portion of the contracted agreement ($400 in your case) the patient is contractually and legally obligated to pay THEIR portion. WAIVING any of that out of pocket routinely (routinely doesn't mean every time for that patient, it means routinely for all types of cases like this). Legally the patient is responsible for THEIR portion of out of pocket and yes, that includes non covered fees. The same would be said let's say for example the patient only has 30 visits a year for chiropractic but they go 40 times, their cost sharing and legal contractual obligation is the other 10 visits according to their plan's policy (contract).   See what I'm saying.  Now you can waive or discount with a proper financial hardship agreement completed but not done routinely, rather done by the office's policy and documented in the patient's file.   

Angie:
Thank you for the clarification Linda, sorry for the misunderstanding. Your information is very helpful.

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