Wiki Doctor not contracted, but hospital is - will hospital get paid?

[jhaines]

The physician I bill for saw a patient with an insurance that he is not contracted with. He is performing wound care at the local hospital, so the hospital bills their portion as well. My question is, the hospital IS contracted with the insurance, so they should get reimbursed, correct? Thank you!

 

[thomas7331]

The physician I bill for saw a patient with an insurance that he is not contracted with. He is performing wound care at the local hospital, so the hospital bills their portion as well. My question is, the hospital IS contracted with the insurance, so they should get reimbursed, correct? Thank you!

Whether or not the physician or the hospital (or neither, or both) will be paid will depend entirely on what benefits the patient has available under their particular plan.

 

[csperoni]

Yes, this varies greatly not only by carrier, but by the plan. It can also depend on the patient status in the hospital.
If the patient was already admitted to the hospital, and then your physician was called in, the hospital would be paid (assuming they already did the necessary admission notification)
If your physician brought the patient to the hospital as outpatient to do wound care, and the insurance requires pre-cert or pre-auth that you did not get, you will definitely not be paid, and neither will the hospital.