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Deductible

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ruthie72:
I am so confused..I am new at this..My question is..when a patient has no copay, and they say that want to pay X amount towards their deductible..when I do the claim do I put what they paid on the claim? OR how does the insurance company know what they paid?? HELP   ???

PMRNC:
Any payment they make is entered with the claim. It's not advisable to collect MORE than each visit. Deductible's are calculated by the carrier on a first come first serve basis, so if you collect for example $100 towards 2013 deductible but other providers or the patient had other claims sent in, the first $100 in patient out of pocket is going to go towards the deductible. I always advise my clients to just take the copay/coinsurance amount. It cuts down on the refund's later.

ruthie72:
Thank you so much. If what the insurance company pays the provider is $62 and the patient keeps paying $65 each time, then the patient is going to have a $3 credit each time is that correct? I am wondering if I should just tell my provider to have her not pay towards the deductible and just bill her the $62$. I do not think she has a copay...what do you think?

PMRNC:
From your example, it's just not really clear. I don't know if the provider is participating, if there is a par adjustment. Benefits for all my clients are verified either through myself or the office staff and normally we just try to collect copay/coinsurance to keep the credit balances at a minimum.

Another way you can approach it is to have patient pay in full with NO assignment of benefits. When patient meets their deductible, have them bring in the EOB to show it's been satisfied.   Again, though I'm going on the premise that this is a non par carrier indemnity plan with coinsurance/deductible. The rules change if it's a carrier your provider contracts with.

ruthie72:
Yes my provider is a PAR...

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