out of network billing

ddcool

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Stonybrook, NY
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HI,

Does a provider have to bill a patient for a non-covered charge? Not asking about ded, co-insurance ore , co-pay , just non-covered.f

Thanks.
 

SharonCollachi

True Blue
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Clovis, CA
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Well, if you give away services for free, then Medicare will want those same services for free. You have to make an attempt to collect.
 

ddcool

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Stonybrook, NY
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It is not Medicare. And we are not giving anything away, the billed charge was $90.00 and they paid $80.00 and says " $10.00 not covered"
 

SharonCollachi

True Blue
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Clovis, CA
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Okay, that's different than a non-covered charge.

What you're talking about is "usual and customary". The insurance has decided that the usual and customary amount for that service should be $80, no matter what you billed. You are under no obligation to accept their decision, and you are allowed to bill the patient the $10 (unless it is any sort of governmental program). You are also allowed NOT to bill the patient, and give them the benefit of the U&C rate.

So either way is okay.
 
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