Payments > Insurance Payments

Balance Billing

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kristin:
It has been years since I have dealt with billing an out of network insurance for a patient, so I have a question...why bill the insurance at all, if not contracted with them? Isn't that just a courtesy to the patient? Why not collect payment in full at TOS, give the patient a receipt, and let them file a claim on their own, to recoup back what they can, if anything? Or is that not allowed anymore?

rdmoore2003:
When filing the claim, are you "accepting assignment of benefits"?  This can cause an issue with an out of network plan.

PMRNC:

--- Quote ---When filing the claim, are you "accepting assignment of benefits"?  This can cause an issue with an out of network plan.

--- End quote ---

Especially BCBS, in most states they don't honor assignment of benefits for out of network providers.

mindy167:
F/U to PMRNC response 08/04/2016 -sorry for delay!

Yes, AOB and have since received info bills processed under emergency care which this insurance will process as in-network even if no contract exists.

Yes, there was an allowable and a not covered portion.

What recourse, if any, can be done to receive the balance due?

Michele:
If no contract exists then the provider can bill for the entire billed amount minus any payment made.  So even though they processed as in network, with the absence of a contract the patient is responsible for the entire amount if that is what the provider wishes to do. 

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