General Category > General Questions
out of network provider
PMRNC:
--- Quote ---I seriously don't get what you just said. The patient signs the assignment of benefits statement. They have insurance. They are signing those insurance benefits over to the doctor. So what do you mean by "if none exists". That is what is confusing me.
--- End quote ---
Well, I'm not sure why a patient would sign an AOB if paying cash/upfront. If there is full payment in the payment field of the CMS1500 but yet there is an assignment of benefits, one had better exist but again, I'm not sure WHY a patient would assign benefits if they have paid for services.
best biller:
My clients patients do not pay up front. Now there is one pt. which stopped coming and when we call to collect payment she does not answer the phone. We want to try avoiding this in the future.
PMRNC:
Like I mentioned I was never aware UHC did not honor assignment for non par providers.. But if they are not but yet you have an assignment of benefits, I would FIRST clarify this with the carrier that they are NOT honoring assignment. I only know that BCBS does this for non par as it's built into their policies. If you establish they are paying the patient properly (even with an assignment) then it might be time to revamp your office financial policy so you can collect full fees at the time of payment for these patients.
Medicare56:
--- Quote from: RichardP on April 25, 2013, 07:03:29 PM ---We have a client who is a non-participating provider for all insurance. Cash only. Patients signs a statement that assigns benefits to the provider. That is noted on the CMS 1500 we send to the insurance company (patient has assigned benefits to provider). Insurance company calculates what they will pay against what we billed and sends that payment to the provider. Provider has patients with United Healthcare where payment is sent to provider, even though provider is non-participating (this is California).
1. If patient paid cash at time of service, and if patient is due a refund after insurance pays, provider's office issues refund to patient (when we tell them what it is).
2. If patient did not pay cash at time of service, we balance bill for the remainder.
The exception is Medicare. Patient cannot assign benefits to the provider, so payment is sent directly to patient.
There are some few other insurances in California that will not send payment directly to the provider, even if the patient authorizes it. You will have to figure out which carriers those are for your own state, since insurance rules and practices vary from state to state.
--- End quote ---
if patient get's the money, how will the provider then compensate for their supply?
PMRNC:
--- Quote ---if patient get's the money, how will the provider then compensate for their supply?
--- End quote ---
Well again, if the carrier did not honor a valid assignment of benefits when they should have the carrier has the responsibility for reprocessing the claim, properly assigning benefits to the claim with payment to provider and then they would seek reimbursement back from their insured/patient. BUT if the carrier processed properly and doesn't honor assignment of benefits OR there was no assignment then the provider is left to bill the patient. THIS AGAIN IS NON PAR
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