ABN for Commercial insurances

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Call me crazy, but I cannot find any factual information on rules for using ABN's for commercial insurance. My main question is, if the denial is for contractual (CO) then can we still bill the patient if there is an ABN signed? I know that you cannot with Medicare, but not sure about non Medicare. All the Premera individual plans in Washington State are denying fundus photos (92250) without a pre auth, which is insane. Even if we get a referral from PCP, they still deny.
 
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169
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New Albany, MS
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Call me crazy, but I cannot find any factual information on rules for using ABN's for commercial insurance. My main question is, if the denial is for contractual (CO) then can we still bill the patient if there is an ABN signed? I know that you cannot with Medicare, but not sure about non Medicare. All the Premera individual plans in Washington State are denying fundus photos (92250) without a pre auth, which is insane. Even if we get a referral from PCP, they still deny.
ABN form only applies to Medicare. There is not an ABN form for commercial insurance. If you are contracted with the insurance carrier you might want to check your contract. If the EOB states that the patient is not liable you can not bill the patient.
 

CBLENNIE

Networker
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Meridian, ID
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I work for a commercial carrier and we do allow our contracted providers to use an ABN to advise a patient that a service may not be covered and the patient's financial liability. Our guidelines are similar to Medicare's and we will accept a Medicare ABN, we also have our version available for providers to use or the provider may use their own but it must meet the criteria outlined in our Provider Administrative Policy regarding the required elements of an ABN. I agree with Orthocoderpgu that you need to follow your contract with each commercial carrier you are contracted with.
 
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Corinth, TX
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and other thing is if its denying for AUTH - try requesting PREAUTH before services provided to avoid AUTH denial, referral is only for Specialist consultation it is NOT same as PRE AUTH - Ankita
 
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