Wiki Not accepting assignment with Insurances

[kcaskey03]

I have a general question about accepting assignment and responsibility of the patient. If we do not participate with an insurance for example, Tricare, and the claim is marked that we DO NOT accept assignment...once we get the EOB back from the insurance, is the amount we charged for the visit-- the full responsibility of the patient .. or do we have to take off any adjustments that the EOB states ?
Thank you for any guidance!!!!

 

[VickieArballo]

It is my understanding that if you are not contracted, you are not required to take the contracted write off. Insurance EOB's will still list them, and a patient may call and question why you did not take the adjustment, but if your office was clear on the billing and clear with the patient when the appointment was made, that you are not a contracted provider, then the write off is not manditory. But be very sure before you balance bill a patient, that there is not a contract for your provider with the payer.

Hope that helps,

Vickie

 

[mdoyle53]

Depends on the insurance.

Medicare for example you can only charge 15% above the allowed amount if you do not participate. Most commercial insurance carriers you can charge your U&C and it will be the responsibility of the patient to pay the difference as you do not participate. I forget the rules around tricare since it is so small in the geographic areas I deal with.