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).
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.
You know I meant your providers/clients
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
You cannot blanketly file an AOB with any carrier (par or non par) if none exists.
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.
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.
if patient get's the money, how will the provider then compensate for their supply?