Biller2023
Networker
We are an out-of-network provider, and as such, we typically do not accept payment based on amounts lower than what we've billed. Our billed amount reflects the fair rate we expect to be paid for the services rendered. While we understand that insurance companies like Aetna Medicare, UHC Medicare, and others may process claims based on the Medicare fee schedule, our concern arises because we are out-of-network with these plans.
In these situations, we believe we are entitled to payment based on our billed amount or, at a minimum, a fair rate that is consistent with published rates like Fair Health. However, despite submitting multiple appeals (first and second level), these insurers continue to deny our claims, stating that the payments were processed correctly based on the Medicare fee schedule and the patient's plan details.
Given this, we are wondering what steps we should take next. Specifically, would filing for arbitration with Maximus be a recommended course of action in cases like this, or is there another strategy we should pursue?
Any guidance or insight you can provide would be greatly appreciated.
In these situations, we believe we are entitled to payment based on our billed amount or, at a minimum, a fair rate that is consistent with published rates like Fair Health. However, despite submitting multiple appeals (first and second level), these insurers continue to deny our claims, stating that the payments were processed correctly based on the Medicare fee schedule and the patient's plan details.
Given this, we are wondering what steps we should take next. Specifically, would filing for arbitration with Maximus be a recommended course of action in cases like this, or is there another strategy we should pursue?
Any guidance or insight you can provide would be greatly appreciated.