General Category > General Questions

2 separate FEE schedules for ONE OFFICE

(1/5) > >>

Med Bill New:
I am dealing with a drug rehab center and they normally charge a flat fee for their entire service.  The fee they charge is way under the standard rate. 

I need to know if it is legal for them to charge one rate for their CASH PAYING PATIENTS and another rate for their patients that have & use their INSURANCE.

I have always thought that doctors offices did this and was wondering if it's legal for a drug facility to do this as well.  I want to stay ethical & legal.

ANy input is greatly appreciated!!!! 

Michele:
It is illegal to charge one fee for a cash patient and different fees to patients with insurance for the same service.  For example, if a patient comes in for a wart removal and they don't have insurance (cash patient) and the dr charges them $50 and then another patient comes in for the exact same thing but has good insurance and the dr charges for an 17111 for $95.  (Of course it would have to be the exact same number/size warts etc)  That is wrong.  The dr is charging higher based solely on the fact that the patient has insurance. 

So in the case of drug rehab, it is ok if they charge a flat fee for their entire service to cash patients and then break the charges out for billing purposes, IF they are charging the same fees.

Angie:
So you cannot have a hardship agreement? I thought I  had read on one of the postings that it needs to be well documented in your policies and that it needs to be consistant. Say the flat daily rate is $400 a day but based on financial hardship the company agrees to administratively write off $100 per day because they have no insurance coverage and charge them $300 a day, is that illegal?

What about if they do have some insurance coverage (non par provider) and they bill the insurance $400 a day and then once the insurance stops funding they review their financial situation and do an administrative adj to the $300 a day, is that illegal???

PMRNC:

--- Quote ---So you cannot have a hardship agreement? I thought I  had read on one of the postings that it needs to be well documented in your policies and that it needs to be consistant.
--- End quote ---

What does YOUR policies and procedures say? how does your office financial policy define hardship?  That's where you get your answers, if you don't have one, well then it's good idea to get that done ASAP. You can have hardship agreements completed by patient's who QUALIFY as per your office financial policy.


Say the flat daily rate is $400 a day but based on financial hardship the company agrees to administratively write off $100 per day because they have no insurance coverage and charge them $300 a day, is that illegal?

That is a cash pay discount, nothing goes to any insurance company. As long as the patient's bill reflects this COURTESY discount your fine. IF they submit to an insurance carrier (even unbeknown to you) the bill MUST show the courtesy cash pay discount.  I think it's only best a practice do this when the patient has paid up front, otherwise they lose their incentive.

 

Angie:
As always, Thank you Linda!
If you are doing an itemized statement for the patient as requested by them because they want to submit to their insurance to try to seek some reimbursement  and they only are requesting an itemized statement of the therapy sessions provided directly by the therapist "Is it wrong to not show the other charges that would not be reimbursed by the insurance or do a full itemized statement of everything even if you know the insurance is going to deny it". 
Say it is RTC program, private pay, cash upfront and OON; The program tried to get it covered by the insurance upon admissions but it was denied because of medical necessity but the patient wants a separate itemized statement showing only the therapy sessions that were provided directly by the therapist so they can submit to their insurance to try to seek reimbursement for those sessions only. Can you provide them with just that? or does it need to show the other charges such as room and board if it is all inclusive in the $375 day rate. Sorry if I am confusing you, I am confused myself!

Navigation

[0] Message Index

[#] Next page