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When a primary insurance payer pays 0 on a 1000 bill and a secondary pays 700 with a 700 contracted amount do you have to pay the difference 300?
With out a doubt...yes. Unless your dentist is a contracted provider through your insurance company, in that case they might have to adjust your account to what the contracted (allowed) fee is per the insurance company. If they are not a contracted provider they don't have to adjust one dime!
IF Patient primary insurance denied claim because provider is not contracted with them will secondary insurance pay on the claim?
yes
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 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.
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.
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.
What group of physicians contracted to provide health care to members at a discounted price are called?
The group of physicians contracted to provide health care at a discounted price is called a Preferred Provider Organization (PPO). These networks consist of doctors and hospitals that agree to provide services at reduced rates to members of the plan. Patients typically pay less out-of-pocket when they use providers within the PPO network.
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.
When insurance pays provider the allowed amount can provider bill patient for the discounted amount?
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".
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
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.
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.
