Out-of-Network Billing

gtaylor

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I work for a Therapists office that bills a lot of out-of-network Insurance companies that have huge Deductibles. For example: We charge $225 for Physical Therapy, the ins allows 56.74, that is applied to the patient deductible. The non-covered portion of 168.26 is considered patient responsibility. We do "accept assignment" on these claims. Here are my questions: (1) Can we collect a flat fee of $75 from this patient and write the remainder off being that we accept assignment for this out-of-network insurance? or (2) If we "do not accept assignment" can we collect a flat fee of $75 from the patient? Thanks for your help!
 
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Bradenton, Florida
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You would be permitted to do this for patients who's insurance plan you are non participating with only if you offer the same exact policy to ALL patients who's plan you are out of network with, regardless of benefits. It would be non-compliant to pick and choose who has this privelage.

The other important thing to remember is this would not be compliant for plans in which you have a contract, are considered in network, or federal payers.

Good Luck!
 

armen

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Atlanta
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I work for a Therapists office that bills a lot of out-of-network Insurance companies that have huge Deductibles. For example: We charge $225 for Physical Therapy, the ins allows 56.74, that is applied to the patient deductible. The non-covered portion of 168.26 is considered patient responsibility. We do "accept assignment" on these claims. Here are my questions: (1) Can we collect a flat fee of $75 from this patient and write the remainder off being that we accept assignment for this out-of-network insurance? or (2) If we "do not accept assignment" can we collect a flat fee of $75 from the patient? Thanks for your help!

You can collected as much as you think you will be able to collect since it is out of network and you are allowed to balance bill. To avoid problems described in previouse post , just do the same way every other office does: send 3 statements, collect as much as you can and wright off the rest as a bad debt. This would not look like as bad as just writing everything off and accepting "insurance only" payment or having certain "privileged" group of patietn who gets the discounts.
 
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