Payments > Patient Billing

Immunizations and Insurance

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PMRNC:


--- Quote ---And don't stop reading and checking into this site!  I read EVERY post and get a nugget of information every time!
--- End quote ---

She gets nuggets but she gives boulders :)

DMK:
That made my day/week/month coming from you!!!!

sandyb52:
Hello, I would like to confirm that I understand correctly, is it that if we are contracted with an insurance company and a patient comes in with that insurance we must charge the insurance, even if the patient wanted to pay cash? 

We are a small medical clinic and our policy and procedures manual states that we offer 15 minute office visits for $50 cash.  We also bill insurances but sometimes the patient will actually end up paying more if we bill the insurance.  Do we have a choice to accept the $50 cash price or must we bill the insurance?  If we are not contracted with an insurance company are the rules the same?

Are we allowed to discontinue taking new insurance patients and just charge the 15 minute cash price if we feel we are becoming overwhelmed with insurance billings?

I thank you so much for your help!!

PMRNC:

--- Quote ---Hello, I would like to confirm that I understand correctly, is it that if we are contracted with an insurance company and a patient comes in with that insurance we must charge the insurance, even if the patient wanted to pay cash?

We are a small medical clinic and our policy and procedures manual states that we offer 15 minute office visits for $50 cash.  We also bill insurances but sometimes the patient will actually end up paying more if we bill the insurance.  Do we have a choice to accept the $50 cash price or must we bill the insurance?  If we are not contracted with an insurance company are the rules the same?

Are we allowed to discontinue taking new insurance patients and just charge the 15 minute cash price if we feel we are becoming overwhelmed with insurance billings?

I thank you so much for your help!!
--- End quote ---

No, if you are contracted with a carrier you cannot arbitrarily work around them, you must bill them, collect the cost shared copay/coinsurance/deductibles from the patient.  Not only is it in violation of YOUR contract with the provider NOT to do so, but it's a violation of the contract between the insured and the carrier as well.

If you are contracted with a carrier your contract will include the stipulations you are bound to in regards to taking new patients. You must follow those guidelines and not just arbitrarily decide not to take any more from that carrier, that's highly unethical.

sandyb52:
Thank you so much for this information!  I am new to this billing world and have been receiving advice, some of which seems to not be so valid - my first thought was to post this question and I am soooo glad I did, what a service you are performing, I hope to have the opportunity to pass it forward and do the same for another person!

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