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casseciella

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I currently work for a lab, we are providing uninsured patients a discounted rate. However, we are a new and upcoming lab, so we are not in-network with many insurance. Therefore, we provide another discount for people with insurance but we are out of network with their plans. Is that appropriate to provide two different discounts, or should we provide the same discount for everyone?

any references you can provide for this information would be great as well!

Thank you!
 
From what I know is if you are in-network with any insurance you have to charge the same rate to all insurances. You can only discount uninsured patients not patient's with out of network benefits from their insurance unless they go through all the paper work of demonstrating financial hardship.
 
I agree, offering discounts to patients with insurance, whether in-network or out-of-network, is a risky practice because of a potential conflicts with false claims act and other laws prohibiting kick-backs and inducements to patients. The substance of this is that your claim must accurately represent the amount you accept as payment in full for the service, which is not the case if you are accepting a lower price from the patient than the amount you represented to the insurance company on the claim. I as understand it, discounting services to uninsured patients is not usually an issue because there is no claim or third party involved. The OIG web site has a number of helpful articles and publications regarding this. However, whatever your organization decides to do, I recommend you have it reviewed and signed off by an attorney or compliance specialist prior to being put into practice.
 
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Thank you to everyone who replied. can you reference or provide any sites to reflect this information. I have look through False Claims Acts, Anti-Kickbacks, and OIG, but I am not finding anything that explains this information. Everything I am finding just reference the fact that we can provide discounts to uninsured patients...

so any assistance with some references would be great!

thank you all again for your feedback!
 
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