I am new to billing medical insurance as we are a dental office that has just started making oral appliances for sleep apnea. I am trying to let the patient know how much she has to pay. I have submitted a pre-auth to her insurance company. We are out of network and I was told she has met her deductibles and they pay 140% of MNRP. I can't find the Medicare fee for the E0486. I have gone the Medicare site but I'm lost. Should the patient pay in full up front because we are not in network. Should I ask for a gap exception so they pay above the Medicare rate? Any help will be greatly appreciated!
I finally spoke with someone from CGS and the E0468 is not covered. So now I'm back to square one. I called UH back and the patient has met their out of network deductibles. I don't know if that helps...