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Out of Netword Providers and Repricing Agreement

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I receive these by fax.   For years, I would call them and ask them to take us off of the fax list since we do not take these agreements.   Of course, they tell us that it is a claim by claim basis.    We do not accept any of these agreements.  There is no contract, therefore, you are not required to accept any of these "agreements"

This is one of my pet peeves!  Drives me crazy.   >:( >:( >:(  They also call us!  They use the "you'll get paid faster" tactic.  If the insurance carrier just paid the claim instead of sending it to you it would have been paid by now.  Also, sometimes the claims are paid when we get the fax!   :o

For my clients that are NON par we have devised a system that will allow the practice to submit a predetermination of benefits to the carrier. We submit the CPT code and our pricing along with a request for a pre-determination and the carrier is obligated to let us know that YES or NO the charge is within U&C or not within U&C. The carrier is NOT obligated and will not give us the U&C (to prevent fraudulent billing) but they will tell us yes or no the fee is within U&C. Using that we can tell the patient  ahead of time they will be required to pay the difference and all other out-of-pocket expenses. This really cuts down on our patient statements as we can tell the patient they are required to pay the difference between the billed amount and the amount the insurance carrier allows as U&C.  MANY of the TPA's will let you fax these and many times you can get a response almost immediately. We don't bother with the out of network repricing requests. This procedure allows us to find out ahead of time what the patient is responsible for.  On a rare occasion if the patient has an EAP plan we will negotiate with the EAP plan.

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