balance billing

  1. K

    Contracted with Medicare/other insurances but not Medicaid

    If a practice is contracted with Medicare and other commercial insurances, but not medicaid.. Does the patient legally have to pay their primary insurance co-pay? For example, the patient's primary insurance is United, but their secondary is some type of medicaid plan. If United decides there...
  2. S

    Billing with primary and secondary insurances

    Looking to verify the proper patient responsibility to bill them in the following scenario as well as the proper rationale. Primary insurance is a high deductible plan through BCBS and allows $3000.00 to the patient's deductible for a patient's surgery on the $5000.00 billed charges. We do not...
  3. M

    Out of Network Billing Strategies for Labs

    Does anyone have any good suggestions on out of network billing strategies to maximize provider collections either from the patient or payer? My experience has been that since the subscriber holds the relationship with the payer, they need to call to negotiate in network repricing. If they...
  4. G

    Patient Calls with insurance info after filing limit.

    If a patient was seen and did not present insurance and was billed for the visit, decides to call with insurance info well after the filing limit for their insurance, are they responsible to pay or do we have to write it off?
  5. G

    MI Auto Carrier Paying Less Than Billed Amount

    I am looking for information regarding Michigan Auto Claims and how to handle the remaining balance. Some of our claims are paid less than the billed amount with the carrier stating it is "above the usual and customary" for our area. We do not have a contract with the auto carrier and feel...
  6. S

    QMB question

    I work for a provider who, up until late last year when I started in the department, had no idea about QMB and prohibition against balance billing these patients. Up until then, if a patient had Medicare & Medicaid, they told the patient we were not in network with Medicaid (which is true, we...
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