Wiki OON payment

Create Wiki
B

Blackhorse

Guru
Messages
227
Location
Irvine, CA
Best answers
0
We performed many Covid testing for OON patients. I'm wondering is there a fee schedule for OON payment or we just take whatever the payment the payer wants to pay us. The reason I'm asking this question is because we have an Aetna PT had 5 testing with us, we got paid 5 different amount for U0003. I called Aetna a couple times and nobody can explain to me why those payment are different.
 
I think they honestly just pay whatever they want. There isn’t any fees associated with being out of network that I have seen. I think we are just at the payers mercy being an OON lab
 
My lab is out of network with most insurance companies (just not aetna) but with the other insurance companies we send an UCR-Usual customary rate appeal. Most of the time the insurance company does pay additional. You can try that route!
 
Tara0513 said:
My lab is out of network with most insurance companies (just not aetna) but with the other insurance companies we send an UCR-Usual customary rate appeal. Most of the time the insurance company does pay additional. You can try that route!
Click to expand...
Thank so much for the good idea.
 
Tara0513 said:
My lab is out of network with most insurance companies (just not aetna) but with the other insurance companies we send an UCR-Usual customary rate appeal. Most of the time the insurance company does pay additional. You can try that route!
Click to expand...
How do you come up with a UCR? I am doing my researching but unsure how you come up with the amount of a UCR per procedure?
 
You must log in or register to reply here.
Top