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Billing Insurance two different rates

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kristin:
I wouldn't let this happen, personally. The provider really should not be changing the amounts she bills to a particular insurance company, because she is telling them that she is willing to go below her average fee of $125, by sending in some claims for $80. Definite red flag. She has to pick a fee, and stick with it, for everyone with that insurance.

What would make more sense is if she bills her regular fee all the time, and has the patient fill out financial hardship paperwork so she can legally reduce the bill down, after the insurance processes the claim.

barb2512:
I would like to know more about the financial hardship paperwork. Specifically if it is listed in the law somewhere so I can give that to the counselor. Please let me know where to look for that online. Thank you.
Barbara

PMRNC:

--- Quote ---I would like to know more about the financial hardship paperwork. Specifically if it is listed in the law somewhere so I can give that to the counselor. Please let me know where to look for that online. Thank you.
--- End quote ---

Physicians offices should and can come up with their own UNIFORM policy on hardships. The law is clear on fraud/abuse, anti-kickback, etc.. "CANNOT ROUTINELY" waive/discount. With that said each practice needs to review their office policies and depending on geographical locations, poverty levels, etc come up with ONE policy and stick with it.

RichardP:

--- Quote from: barb2512 on September 29, 2014, 02:28:52 PM ---I would like to know more about the financial hardship paperwork. Specifically if it is listed in the law somewhere so I can give that to the counselor.
--- End quote ---

Google on "MEDICAL PATIENT" + "FINANCIAL HARDSHIP"  (include the quotes)

You will find much information down that path.  See also the following link.  Your questions are discussed starting at Page 32, middle of page.

http://www.donself.com/documents/Billing-Compliance-Manual.pdf

Barb - having said that - we've had this discussion before.  You can get a sense of what the larger discussion is about by reading my comment at the following link.  But you can gain some useful perspective if you read the entire thread.

http://www.medicalbillinglive.com/members/index.php?topic=7116.msg21514#msg21514

Here is a condensed version of my point at that link.  This gives some larger context to the questions you are asking:

... price discrimination by physicians and hospitals is legal.  The Robinson–Patman Act of 1936, an amendment to the Clayton Antitrust Act, prohibits price discrimination - but only for commodities.  It does not prohibit price discrimination for services.  And hospitals and insurance companies and doctors do engage in price discrimination - all quite legally.  For those interested in more information, Google on "price discrimination" + healthcare (or 'doctors').

... there is no law that says a doctor or hospital has to charge the same fee (and publish a list of fees) for the same service to every patient.  Google and read as I recommended above and you will see that this is not just my opinion.

Even though the law allows a doctor and a hospital to charge whatever they want to whomever they want (for services rendered), this freedom is constrained in certain circumstances.  And Billergirlnyc points to some areas where these constraints might kick in; e.g., a doctor's contract with an insurance carrrier (including Medicaid and Medicare), HIPAA and ACA requirements, and any state regulations.  But these regulations only constrain price discrimination in pre-defined circumstances - they don't prohibit price discrimination in all circumstances.  Therefore, it is to a doctor's benefit to consult with a health-care attorney who knows which state and Federal regulations will constrain that particular doctor's practice.

barb2512:
Thank you very much. I look forward to reading your article.

Barbara

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