Wiki Billing in network and out of network insurance companies

[dalinkatie]

I have a patient that has BCBS as primary and UMR as secondary. We are out of network with BCBS but in network with UMR. I send the claims to BCBS first, get payment back from them and then send to UMR. My question is because we are out of network with BCBS we bill our normal amount but when we bill UMR I only bill what is allowed. In that case when I bill for this patient I bill the original amount to BCBS and then the original amount to UMR, do I need to write off anything that the two insurances pay because we are out of network with BCBS?

 

[sls314]

I have a patient that has BCBS as primary and UMR as secondary. We are out of network with BCBS but in network with UMR. I send the claims to BCBS first, get payment back from them and then send to UMR. My question is because we are out of network with BCBS we bill our normal amount but when we bill UMR I only bill what is allowed. In that case when I bill for this patient I bill the original amount to BCBS and then the original amount to UMR, do I need to write off anything that the two insurances pay because we are out of network with BCBS?

Am I understanding correctly that you're billing different billed charges to each insurance company based on what that company allows? Why?

You should have a standard set of fees that gets billed to all payors, then make the appropriate adjustments after the remits come in.

You're likely shortchanging the practice by only billing what you think the allowed amount would be. Additionally, you're creating way too much extra work for yourself by trying to do that.

It also makes things messy when a patient has more than one insurance carrier - especially if something changes with the COB and you have to reverse the primary/secondary order.