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Deductible

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PMRNC:
OHHHH wait.. I think I got ya now ;)

 
--- Quote --- 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
--- End quote ---
...

If the carrier is PAYING $62 a week (I don't know billed amount though) MOST likely there is no deductible, OR it has been satisfied. You have to look at the EOB because you will also have a participating provider adjustment unless you are billing the allowed amount.  IF this is a participating plan, then technically you should NOT be collecting that much from the patient.  But without knowing HOW much was billed, how much was allowed, I can't say for sure.

ruthie72:
I will try to make myself a little more clear (I am totally confused so bear with me). Okay So the provider's fee is $75 always..the allowed amount that the insurance company pays is $62. The patient has been paying the provider $65 each time she has been in because she says she has to pay it towards her deductible, (why she thinks this, I am unsure). So..now when I go to do the claim, how do I treat this? Thank you..I really hope this makes sense.

PMRNC:
So the carrier is allowing 62 and paying 100% of the allowable ($62)?  If so then she has NO out of pocket. If the $62 is a payment of another "allowable" the patient would owe the difference. For example if the carrier allowed $70, and paid $62 your adjustment is $5 and patient is responsible for $8 per visit.

ruthie72:
that make sense, thank you..what if she does have an OOP? Then what would the patient be responsible for. Sorry I am asking so many questions. Thank you so much.

PMRNC:

--- Quote ---that make sense, thank you..what if she does have an OOP? Then what would the patient be responsible for. Sorry I am asking so many questions. Thank you so much.
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Well if the provider is participating with the carrier then usually the EOB will tell you the patient responsibility which is normally the difference between the allowable and the paid.  about 95% of all EOB's have this right on it so you know what to bill the patient and what is adjusted off.

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