General Category > General Questions
out of network provider
PMRNC:
--- Quote ---We (billers) don't have the patient sign the AOB. The doctor does. There is a certain logic to why he does it, given that there is an in-house lab involved and he doesn't charge the patients cash for the labs. Mostly, doc just wants to make certain he gets paid for everything he does. If there is any money left over, he refunds it to the patient.
--- End quote ---
You know I meant your providers/clients ;) I imagine with labs unless patient pays up front there would be an AOB, but for my clients they know if a patient pays cash NOT to do assignment of benefits. I used to work for a few carriers and the patients that would call and complain about that was a big thing, technically a carrier can flag a provider for it if they are receiving payment and sending in an assignment of benefits. I've seen carriers that don't ACCEPT assignment for non par but never seen one that wouldn't send payment to patient. Policies are between patient and carrier.
RichardP:
--- Quote from: PMRNC on April 26, 2013, 07:24:48 PM ---You know I meant your providers/clients ;)
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Actually, I wasn't sure, and I didn't want to presume. What with all the talk about billers growing into practice management, and sometimes becoming practice managers and running the doctor's office ...
As a non-par guy, including Medicare, his fees are quite a bit higher than what the insurance pays. When the insurance payment goes to the patients, they too often find other things to do with the money than pay the doctor. This setup ensures that the doctor gets his money first, so he can stay in business and provide top-notch care to his patients (not all patients can pay 100% of what they owe for each visit, and the doctor tries to accomodate his patients). New patients are notified of this setup before the doctor does any procedures, so they are free to go to another provider if they don't like it. Some go, but most don't. Given that doctor is out of network, the patients would have to bill the insurance themselves to get reimbursed. We bill for them as a courtesy, and most appreciate that. We have a number of non-par clients who do this. They've been clients for ten years and we haven't had any problems yet.
On a slightly different note, but sort of related: here's a slice of life. Most of our clients are located in Beverly Hills and are a mixture of old and young and in-the-middle, age-wise. They serve a healthy segment of the entertainment industry, both old and young. Consider our clients who have been cash-only to this market for the past 40 years. They charged whatever they wanted, and got paid for it. Then the patients, who have never ever balked at paying outrageous rates for top-notch medical care (Edit: they have accountants pay for it all 8); life's been good to them so far), turn 65. Time for Medicare. So the patients sign up, in spite of their wealth. Suddenly, a cash patient is now a Medicare patient and we must bill Medicare (participating provider or not). Suddenly, charges that used to bring in thousands now only bring in hundreds. Doctor's income takes a major hit, but so does ours (since we charge a percentage). Over the past five years or so that has affected a couple of our clients - and by extension, us - big time. Didn't see it coming until it occured. It makes sense when you think about it - the patient letting Medicare pay for stuff that the patient used to pay for. It was just not something we thought through until it began to happen.
(Brownie points for those who get the reference.)
PMRNC:
--- Quote ---As a non-par guy, including Medicare, his fees are quite a bit higher than what the insurance pays. When the insurance payment goes to the patients, they too often find other things to do with the money than pay the doctor
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I get that..but that's what AOB is for.. You cannot blanketly file an AOB with any carrier (par or non par) if none exists.
RichardP:
--- Quote ---You cannot blanketly file an AOB with any carrier (par or non par) if none exists.
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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.
I edited my last post slightly while you were posting.
best biller:
Thanks so much for the info.
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