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Wiki Out of Network Provider Different Charges

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b3ckalano

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99% sure I know the answer but I'd love to confirm

A provider cannot charge different rates for the same service based on what the insurer allows, correct? And this applies to both in and out of network providers, yes?

As an out of network provider doesn't have a contract with the insurer I thought there might be some leeway - but this is a general billing rule and not specific to any insurer, right?

THANKS IN ADVANCE
 
There are a lot a pitfalls involved in charging different rates to different payers, and it's certainly possible that in some cases it may be against regulations and/or laws, depending on how and for whom it is done. It's almost always strongly recommended that providers do not do this, but I don't know of any specific blanket law that actually says it's illegal in all cases. But I'm not an attorney and this isn't the proper place to give or receive legal advice. You'd best get an answer to this from a reliable source - a legal expert who is familiar with the laws of the state where the providers are practicing and who can get any additional information from you about exactly what the providers are doing in order to come to an informed decision as to whether or not it is violation of any particular law.
 
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