jhaleycoder
Contributor
If a drug is considered non-covered by the patients insurance. Can the patient pay cash for the drug and the physician bill the insurance for the administration example 20610 and an office visit if warranted?
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Wiki Billing insurance for injection and patient for drug
- Thread starter jhaleycoder
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haraml7
Guru
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Yes and NO, you will send all appropriate CPT codes to your insurance company, then when the insurance company does not cover the code and the insurer says it is the patient's resp then you bill the patient. For example, CO-96 would not be the patient's resp as this type of denial is a contractual issue between the dr and the insurance company, but if the EOB states PR-96 then the patient can be billed because the patient's benefits do not cover this drug.
Also, what is the reason for the insurance not picking up? is it experimental or is in the patient's benefits plan that this particular drug is not covered per their benefits.
Also, what is the reason for the insurance not picking up? is it experimental or is in the patient's benefits plan that this particular drug is not covered per their benefits.