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When insurance pays provider the allowed amount can provider bill patient for the discounted amount?
Wiki User
∙ 13y ago
Only if the physician is a non-participating provider who does not accept assignment. The physician can bill the patient the difference between the actual charge and the allowable charge. This is called "balance billing".
Wiki User
∙ 13y ago
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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.
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.
What happens if doctors dont send bill to insurance in time allowed?
If the provider exceeds timely filing limits with the insurance carrier the provider cannot bill the patient. The provider must have a participating contract with the insurance carrier also.
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
Should the Dr's office bill the patient for the Provider Discount that the insurance company gets?
If the dentist is part of the insurance company's network, he or she is contracted NOT to balance bill the patient for the discount negotiated as part of the contract. The dentist can charge for the difference between the discounted rate and what the insurer pays. For example, if the usual charge for the procedure is $100 but the discounted amount is $60 and the insurer pays half; then the dentist can charge you $30. But the dentist should NOT be charging you the $30 PLUS the $40 discounted amount. If this happens you should contact your insurance company as the dentist may be in violation of his or her contract.
Who are the three participants in the medical insurance relationship?
Provider, Patient, and Health plan
Do medicare allowed charges apply for what one may be charged by a doctor if the patient is elligible for Medicare part B but has not enrolled in it?
I think not. It seems unlikely that a provider would be limited to the rates of an insurance carrier, such as Medicare, of which the patient is not a member.
IF Patient primary insurance denied claim because provider is not contracted with them will secondary insurance pay on the claim?
yes
Is a provider RESTRICTED BY LAW FROM BILLING A PATIENT IF THE PATIENTS INSURANCE CARRIER DEIES THE CLAIM PER timely filing agreement?
Yes per the provider contract, they are required to file claims to the insurance carrier within specifiec time periods. The provider can NOT bill the patient if they have not done so.
Offset scenario in medical billing?
Offset- It means adjustments of debts payments to be received against the credit payable. If there is a overpayment made by insurance company to the provider, then the insurance company will adjust by deducting the amount from other patient claim. For example : If the provider billed a patient claim for $250 and the actual allowed is $200, if the insurance paid $250.00 then the excess amount of $50 will be adjusted in another patient claim. Both are correct. Its the process of reversal of old claims and posting the amount to new claim.
If a doctor give a patient a 20 percent discount do you have to file the discounted amount to insurance?
Is it the patient or the dentist that is filing for insurance payment? A dentist that is in a network, is contractually required to file the discounted charge given to the patient. Any payment made from the insurer is governed by the terms of the insurance policy. If the policy indicates that the patient files a claim based on the charge and requires a copy of the billing to support the claim, then the patient is bound to report the fee charged, i.e. the discounted fee. If the patient (and/or the doctor) files a charge other than the actual charge, they could be engaged in fraud. Shorter answer not based on law but what is ethical--yes.
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.
