Wiki Balance Billing?

wonder1963

Networker
Messages
54
Location
skiatook, OK
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Can the Deductible be higher than the allowed amount?
Example Billed 53.00
Allowed 30.01
Deductible 41.60
RC-Amount 22.99
Paid -11.59

PR 41.60

Can someone explain this?

Would the provider bill the patient 41.60 or 30.01? Would this be balance billing? Is it Legal?
 
The patient owed $41.60 towards their deductible before your bill processed. They applied the allowed amount of $30.01 towards that deductible so that is what I would bill the patient.

($41.60 - $30.01 = $11.59)


He/she still owes $11.59 towards the deductible after your bill processed, so "-11.59" is still outstanding.



That EOB is clunky for sure
 
If this is the only information you have, think you're going to need to contact the payer to get clarification because these numbers don't add up correctly. If your billed amount is $53.00 and the insurance paid $11.59, then the balance (before any adjustments) should be $41.41, not $41.60. It's possible that there is an interest payment included in the $11.59. If you are not contracted with the payer, the you don't have to write off the $22.99, unless your state imposes a more restrictive balance billing law. I don't know why the deductible would be more than the allowed amount, but it may just be a peculiar way that this payer identifies amounts on their remittance. I think you need additional information in order to post this correctly to the patient's account.
 
If this is the only information you have, think you're going to need to contact the payer to get clarification because these numbers don't add up correctly. If your billed amount is $53.00 and the insurance paid $11.59, then the balance (before any adjustments) should be $41.41, not $41.60. It's possible that there is an interest payment included in the $11.59. If you are not contracted with the payer, the you don't have to write off the $22.99, unless your state imposes a more restrictive balance billing law. I don't know why the deductible would be more than the allowed amount, but it may just be a peculiar way that this payer identifies amounts on their remittance. I think you need additional information in order to post this correctly to the patient's account.



The paid amount is Negative 11.59 (-11.59) so it does balance but I am having a difficult time understanding why the deductible is higher than the allowable, are they saying the 11.59 is a write off in addition to the 22.99 (assuming this is an in-network claim)

Tiffany
 
The patient owed $41.60 towards their deductible before your bill processed. They applied the allowed amount of $30.01 towards that deductible so that is what I would bill the patient.

($41.60 - $30.01 = $11.59)


He/she still owes $11.59 towards the deductible after your bill processed, so "-11.59" is still outstanding.



That EOB is clunky for sure

It is most definitely clunky, so the 11.59 would be a write off basically? In addition to the 22.99?

Tiffany
 
How can a paid amount be negative? Are they coordinating with a primary insurance? Best to just call the payer and find out - there's not enough information here for anyone to know the correct answer, we can only guess. Or if you cannot get the information and your practice is not contracted with that payer, then I would bill the patient for the full balance due.
 
I think the $11.59 is for informational purposes only so I wouldn't do anything with it.

I would post this like any other payment that is applied towards a deductible: allowed amount is $30.01, write off is $22.99, payment is $0.00 leaving $30.01 patient responsibility.

But that is just my interpretation...
 
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