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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Related Questions
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 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 a surgery doctor?
A surgery doctor is a doctor who performs surgery in a specific area.
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.
Will insurance cover breast reduction surgery?
Some insurance companies do cover breast reduction surgery. You have to contact your insurance provider and ask for details or if you go to your family doctor/chiropractor they can let you know your options and write you referrals for the insurance company. I had reduction surgery and my insurance (Blue Sheild PPO) covered all of the costs for the reduction, both my chiropractor and surgeon wrote letters of recommendation along with pictures to back up their reasoning. I would contact your provider or doctor and go from there.
Talk To The Doctor About Money?
If money is an issue that is stopping you from getting bariatric surgery, then talk to your doctor. Bariatric surgery financing is usually not dealt with through insurance companies, but if the doctor can prove it is medically necessary, sometimes the insurance company will put it through. Some doctors will let patients set up a payment plan so they can have the surgery. If you own a credit card, you might want to consider putting the surgery on your credit until you can pay it off.
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.
How can I find out if my insurance covers a gastric bypass surgery?
To find out if your insurance covers a gastric bypass surgery you should call your insurance company. If you can not reach them by their telephone number I suggest you see if they have a website. You could also consult a doctor, they usually know what insurance companies cover certain surgeries.
Your doctor is holding back on your surgery because of your insurance can the cancer spread?
Yes. You need to take steps to get into treatment sooner if the only holdup is an insurance issue.
Is there any kind of cosmetic surgery insurance at all?
There are cosmetic surgeries that insurance will cover as long as it is medically necessary. Examples would include breast reduction, eye lifts and nose jobs as long as a doctor can prove to the insurance company that the surgery is medically necessary.
Can you sue the Workers Comp Insurance for not authorizing the surgery the Doctor recommended?
Sure hope so. I am in the same boat
What factors affect the cost of eye surgery to correct vision?
Surgery to correct vision can be quite expensive. However, many factor may affect the cost. Call your health insurance company to see if they offer benefits for this service. Some insurance companies will refer you to a doctor who charges lower fees. You can also lower your fees by choosing the lowest service that they offer. Most providers offer a simpler surgery for a lower price. They also charge more for blade-free surgery.
Where can I go in michigan to have lasik eye surgery?
There are many locations in Michigan that do lasik eye surgery. The cheapest way to go about having lasik eye surgery is to find a doctor who is covered by your medical insurance plan.
What insurance does ucsd medical hospital accept?
I'm 73 and on Medicare. The insurance I have now for Victor Legner UCSD primary care doctor will be discontinued Dec. 31, 2013. I need to know what insurance (HMO's and PPO's) UCSD Hospital and Dr. Legner will accept in 2014?
Does a doctor have the right to charge you more than the copay on your insurance?
That depends on 2 factors..1. is your doctor in your insurance company's network if no then yes he/she can charge you up to the billed charges subtracting what if anything your insurance company paid. 2. Is things like labs, x-rays and procedures covered under your copay or do they apply to your deductibles and coinsurance? When in doubt contact your insurance company
Where can I find out more about gastric bypass surgery insurance?
Gastric bypass surgery inruance information can be obtained from your local doctor, pysichian, or even your gastric bypass representative to help you.
What does DDS mean for a dentist?
Doctor of Dental Science, or could also mean Doctor of Dental Surgery.Doctor of Dental Science, or could also mean Doctor of Dental Surgery.Doctor of Dental Science, or could also mean Doctor of Dental Surgery.Doctor of Dental Science, or could also mean Doctor of Dental Surgery.Doctor of Dental Science, or could also mean Doctor of Dental Surgery.Doctor of Dental Science, or could also mean Doctor of Dental Surgery.
Is there a doctor that works in a hospital but does not do surgery?
there is a doctor that works in a hospital that does not do surgery. Not all doctors have to do surgery in a hospital.
How much does the gastric band cost?
To determine the cost of gastric bypass surgery, it may very depending on which insurance company you have. consult your insurance provider to get an estimate along with your doctor.
