Wiki out of network billing

ddcool

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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.
 
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.
 
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"
 
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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