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IF Patient primary insurance denied claim because provider is not contracted with them will secondary insurance pay on the claim?
Wiki User
∙ 15y ago
yes
Wiki User
∙ 15y ago
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Does a provider have to bill secondary insurance even if the patient prefers to pay out of pocket?
If the provider is out of network or not contracted with the secondary insurance, they do no have to bill the secondary and the patient is responsible for the balance (if any) owing
Can an In Network provider offer a discounted Self Pay package to a patient as an alternative if they are contracted with their insurance company?
In most cases the provider can not. The provider is obligated to bill the insurance. The reason is such transactions can lead to insurance fraud.
If the primary insurance allows more than the secondary insurance what would the secondary insurance pay?
Secondary insurance will not pay the claim but the remaining charges should not be billed to the member/patient. Provider of service should write off the patient responsibility that primary insurance applied.
Are health care providers obligated to accept payment from a secondary insurance with whom they participate when the provider does not participate with the patient's primary insurance?
Yes they will have to accept payment from the secondary insurance, however they will have to bill the primary provider first. What ever the primary insurance does not cover should be covered by the secondary insurance. However, it will depend on the service being provided and the contracted amount that each insurance has agreed to pay. If the primary pays more than the secondary would have paid -there may be a refund due. However, there may be co-pays and deductibles to be met with both insurance policies. There could also be write downs--- you should only pay the lesser amount the provider may have to take a loss if one insurance has a lower contracted amount
Can a medical provider bill the patient the difference insurance company pays?
No, they shouldn't be billing you for the provider discount if the hospital is contracted with the health insurance plan.
Can a noncontracted hmo provider bill a patient?
AnswerYes. "Non-contracted" means there is no contract with the insurance company to prevent the doctor from billing whatever he likes.
Can a provider bill the patient though he is contracted with local blue cross if patient has an out of state plan?
Providers who are not "in network" for the particular version of Blue Cross cannot be sure of being reimbursed for treatment they provide. Thus, they must bill the patient, who then takes on the responsibility of dealing with the insurance. Most providers will assist with this, if asked. This is an issue with the insurance company, not with the provider.
If the doctor is a non contracted provider with medicare, is the physician liable for submitting claims on behalf of the patient?
No, as a non-contracted provider with Medicare, the physician is not required to submit claims on behalf of the patient. It is the patient's responsibility to submit the claim to Medicare for reimbursement. However, the physician may choose to submit the claim as a courtesy to the patient, but they are not obligated to do so.
May the provider bill the patient more than the insurance contracted rate?
It is possible. Some providers will make the distinction between accepting an insurance payment and accepting it as payment in full. It is called balance billing.
How much is a patient liable to pay for surgical procedures?
You would have to look at the summary page of your policy. Whatever the insurance company says you have to pay.... or if the provider is not contracted, whatever they want to bill you.
When is it appropriate to file a patient's secondary insurance claim?
nome
What notification is sent from the insurance carrier to the patient and the provider after an insurance claim has been processed?
The Insured Person will receive an EOB (Explanation of Benefits) from the insurance company which explains the payment by the insurance company, the allowed charge based on contract rates with the provider, and the remaining amount if any that is due from the patient to the provider.
