Payments > Patient Billing

Discounting patient responsibility for non par insurances

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paulette:
Thank you so much for the input! 

PMRNC:
With any policy you have to make a reasonable request/attempt for out-of-pocket/balance.
The patient also has a contracted liability with the insurer to pay Out-of-pocket expenses (coinsurance, deductibles)

Pay_My_Claims:

--- Quote from: PMRNC on March 03, 2009, 04:23:26 PM ---With any policy you have to make a reasonable request/attempt for out-of-pocket/balance.
The patient also has a contracted liability with the insurer to pay Out-of-pocket expenses (coinsurance, deductibles)

--- End quote ---

But of course...we are just speaking on what we can actually bill for.

PMRNC:
I think there is still confusion between "allowed" and "Not allowed"
The example is vague If we are talking "NON PAR"
If the patient has a cost sharing plan the provider does not participate there is still the contract between the insured and the ins company which says the patient is responsible for any "out of pocket".. this includes deductible, coinsurance and non covered charges. Thus just saying the non par plan disallowed an amount is still vague.. why was it cut? U&C?
If they were par the disallowed amount is a write-off / Adjustment.  If it was cut for being over U&C the patient is responsible, they can choose to appeal the charge and the provider can help them attempt the appeal (op report, office notes, etc) and then AFTER reasonable attempt the provider can write-off the non allowed portion.

In the case of billing... IF you know ahead of time what the carrier is paying/allowing on a claim and that you are going to waive the out-of-pocket, that's fraud. We call that TWIPPING (Taking what Insurance Pays) The insurance company had the same right to the same discount which of course then would have reduced the payment (makes sense)

It's not illegal however to waive an occasional patient's balance. An office policy or P&P should be in the office that states the proper way to determine when to waive and how to write-off. Patient's that are hardship cases should complete a financial hardship agreement.

I know this was about billing, but was just concerned others reading would get confused by using the term "allowed"

Pay_My_Claims:
What is confusing about it??? The allowed is what the ins company allows for that procedure. If we bill 600 and they allow 500 and the client is covered at 100% (ins paid 500)means I can bill for the other 100 since I am non-par. Non participating, Out of network. If I was a par provider, in network, participating, I would have to adjust off the 100 as a non allowed charge. I have never heard of the term TWIP, but ok, I will definately research that.

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