Medical Billing Forum

General Category => General Questions => Topic started by: Kassi1140 on January 13, 2021, 11:47:10 AM

Title: Balance Billing?
Post by: Kassi1140 on January 13, 2021, 11:47:10 AM

I am new to medical billing, and still learning my way around the field, and I need a little assistance.

The urgent care I work for offers Rapid COVID testing. The problem is most insurances do not cover the cost paid for the inventory of the test (often times they pay WAY less) so the office has been offering this as a self pay only service.
A patient submit their receipts to their insurance for reimbursement, and the representative from United Health Care says that the office has to reimburse the patient the difference of what they would pay since we are in-network. This is a unique situation that I have found very little resources for information on. Would this be considered balance billing? The office has patients pay up front, and they are aware of the cost of the test before their visit. The office is not discriminating insurances, as this particular test is not billed out to any insurance. I am aware if you bill one insurance, you have to bill all in-network insurances.

My question is: Is their something the office can do to keep this test self pay only, (without insurance hassle), or something that can be done so the insurances will pay more (since they are not covering the cost paid for each test)? Would a self pay waiver stating they understand the costs of the test help at all? (located in California)

At this point it seems as if it will cost the doctor more to provide Rapid Testing if the office accepts the rates currently paid by insurance companies.
Title: Re: Balance Billing?
Post by: Michele on January 14, 2021, 11:42:32 AM
That is a problem.  But unfortunately since they already are in network they can't just choose to be out of network for the COVID testing.  They can only charge the self pay rate when it's not a covered reason for the testing (travel, just want to know, etc).  But if it's due to symptoms or exposure, and the insurance will cover, then you can't charge the self pay rate.