I had a question presented to me in regards to fee schedules and pricing to Insurance Payers vs Private Pay. This is in regards to Laboratory billing, when we are unable to obtain In-Network status, our claims have been processed at 100% by some BCBS, and the patients are upset saying that is unreasonable. We do not ask for that amount, BCBS chooses to process the charge at 100%, and for our other Payers that we are In-Network, the contracted rate applies and no problems. The question was raised, can you cap a claim to an Insurance Payers that you are not In-Network? And what governs the amount you set your Usual and Customary Fee Schedule, are there guidelines written somewhere to help advise what method could be used? We do realize the normal industry is I believe 2 and half times medicare allowable, but is this a law, or requirement, are there limits, are the fee considered excessive? Just trying to educate myself on Fee Schedules and what can and can not be done, correctly! Thanks!