Payments > Patient Billing

Discounting patient responsibility for non par insurances

<< < (3/3)

PMRNC:
Yes when speaking of a PARTICIPATING PLAN the "Allowed Amount" makes sense as the rest is adjusted off as a par adjustment. However when a plan is "non par" the amount NOT covered has a different reason..the amount being considered is usually based on U&C, NOT fee schedule.
For example, my dermatologist is not par with my carrier.  I had a procedure done last summer in which was billed $800, my carrier "considered" $680 and paid $664 ($16 was not paid due to being above U&C). I was responsible for the remaining $136, if I wanted to appeal the additional $16 that would have been up to me.

I probably am over thinking this.. it's just usually when a plan is NON par they explain the amount not considered and what they do consider is not listed as "allowed amount" only.
Hope that makes better sense.

Navigation

[0] Message Index

[*] Previous page