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You might really be asking two questions here.
1. Is it legal, as in can the provider find himself with criminal charges for doing it
2. Does the Insurance Company permit it? Could the provider lose his HMO or PPO contract?
- 1 Here's an answer from Minisota's Medicaid site
Clarification of DHS Copay Guidelines Providers cannot deny services to recipients unable to pay a copay. A provider must accept a recipient's assertion that he or she is unable to pay a copay and cannot require additional documentation of inability to pay. An unpaid copay is considered to be unpaid debt, and the provider is not required to continue to serve recipients with outstanding debt. If it is the provider's general practice to refuse to serve all individuals with outstanding debt, and the provider gives the recipient advance notice and a reasonable opportunity to pay the debt, and the recipient does not pay the copay(s) owed, the provider can then refuse to provide care. Recipients retain the ability to seek services from other enrolled MHCP providers. Providers may choose to continue to serve recipients who are unable to pay the copays. Note: If the recipient is unable to pay the copay, providers may accept payment of the copay on behalf of the recipient from another source.
http://www.dhs.state.mn.us/main/groups/business_partners/documents/pub/dhs_id_010456.hcsp
for more information see www.steveshorr.com
- 2 I've always been told that in an HMO or PPO the provider wasn't allowed to waive fees, but I haven't seen an actual contract or rule.
Even in the Minisota rules - it appears the provider cannot waive fees, except under special circumstances
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I was told my doctor can not charge my insurance for my office visits for up to 3 months following my surgery If they are related to the surgery true or not?
That doesn't sound right. Call your insurance carrier or consult your insurance manual for the exact details.
Will a doctor accept what an insurance would pay if the patient has no insurance?
Some do and some do not. You have to check with each individual doctor.
Can a doctor charge you more for the remainder if the insurance pays what it is worth?
The doctor bills insurance for your office visit. Insurance will pay the doctor their contracted rate and the rest is written off. if you are billed for charges after the insurance paid, call your insurance company.
When is gastric bypass surgery covered by insurance?
Gastric bypass surgery is generally covered by insurance when it is deemed medically necessary by a doctor. This basically means that in order for your gastric bypass surgery to be covered by insurance you would have to be very obese (not just overweight).
How much does it cost to have the bariatric surgery?
The cost of a gastric bypass/ bariatric surgery depends on the doctor, the hospital, and if the insurance company will pay for any part of the surgery.
Will insurance cover a septoplasty?
You can check the details with your insurance company, but the surgery would need to be proven medically necessary. You can discuss that with your doctor.
What is a surgery doctor?
A surgery doctor is a doctor who performs surgery in a specific area.
What does accept assignment mean?
When a doctor or hospital sends a bill to an insurance company, the insurance company in turn sends them an offer of a lesser amount to pay the bill. The doctor or hospital then decides whether or not to accept the offer or "assignment." Most of the time they accept it so they can get paid without any problems.
What is the price for bariatric surgery?
You need to check with your doctor to get a more accurate price as far as cost to you for this surgery. Cost all depends on what type of insurance coverage you have, what they cover, and what they won't cover. Sometimes if you are lucky you can get it 100% covered by your insurance company including the cosmetic surgery afterwards to remove the excess skin that will be left behind if your doctor deems your surgery medically necessary.
How much does it cost to have bariatric surgery?
The cost of bariatric surgery depends on the place the surgery is done, the doctor, and if the insurance will pay for any of the expenses. Some insurances pay money on bariatric surgery depending on if it is a need.
How much does retinal surgery costs?
It is difficult to say how much retinal surgery costs. The price is dependent on the location of the surgery, how much a particular doctor charges, as well as on whether or not one has insurance.
Can you sue the Workers Comp Insurance for not authorizing the surgery the Doctor recommended?
Sure hope so. I am in the same boat
