New Technology Procedures/Services


St Louis
Best answers
I'm wondering if its appropriate for a provider to offer new technology services and materials to patients on a cash pay basis if codes and fees have not yet been assigned? I know unlisted codes are available but with no set fee you run the risk of insurance reducing reimbursement sometimes lower than provider cost. Does it violate insurance contracts to notify the patient upfront that this service is new and not covered by most insurance companies so we require payment in full and not file to their insurance? Would they need to sign an ABN type form or is there a waiver of insurance liability than can be signed on a service by service basis?

On a side note- My OB told me that she doesn't file Flu shots to any insurance, she only does them as cash pay... she is contracted with my insurance so how is that appropriate to refuse billing something that does have a code and a fee?



True Blue
Worcester, MA
Best answers
If you know its not covered by insurance have the patient sign a waiver, Medicare would be the ABN, other insurance may have their own form or commercial may just accept something letterhead sting what the service is, that its not covered and how much they will be responsible for and have them sign it.

For Flu shot I don't know how you do it there but here in MA we don't have any restrictions on where patient get their flu shot they just need to send in a receipt if the provider won't bill the payer. It wouldn't hurt to contact you insurance customer service and ask them what to do.