Payments > Patient Billing

Immunizations and Insurance

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GCPH:
Hello,
We are a small Public Health agency, and we are looking to start billing for immunizations.  We have a few questions regarding private insurance.

We currently hold immunization clinics offsite for local employers.  (The plumber wants all his employees to have Hep A shots.  We go to the office and provide shots.  We bill the plumber directly, and he pays for the shots.) 

Right now we do not bill ANY insurance companies.  Our question is, if we start billing private insurance companies (for our walk-in and well child clinics,) would we still be able to hold employer clinics like above, or would we have to bill insurance for each employee?  Is it an all or nothing deal, or does it depend on insurance in/out of network status?  (We get in-network with BCBS and not Cigna. 7 out of 10 of his employees have BCBS.  We bill BCBS for those employees, and we bill the employer for the other 3 Cigna employees)

Thank you for your help with this.  We are so new to the billing world. 
Thank you!!!

PMRNC:
If you credential with carriers you won't be able to pick and choose who goes through insurance and who doesn't. That's the idea of signing the contract with the carrier, you will get up to the approved rate and every patient is responsibly for their copay. You could work it out to the employer to pay the copay instead, just so long as your NOT making more than the allowable rate for the participating carrier. For example, if your shot is $80 and the carrier approves $60 and patient has a $10 copay, you could have the employer pay the copay's so you'll be getting $70 per $80 shot.   You also can not arbitrarily waive patient out of pocket either, patient's must mee their cost sharing obligations under their plan unless there is a documented hardship.

GCPH:
I was afraid of that.  Thank you so much for your assistance on this.  I've learned more in the past 2 days on this site, than 6 months of research on my own.

Thank you!
-a

PMRNC:
Your very welcome :)

DMK:
And don't stop reading and checking into this site!  I read EVERY post and get a nugget of information every time!

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