Wiki Question on network rates

Kar116

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I have a dilemma right now and would like your input. The doctor's credentialing expired since he had overlooked the paperwork for renewal for as a network provider so he was termed 4/1/2013. Since he wont be renewed until the first of December, the claim is applied to the deductible. He wanted me to call the insurance company and ask what the network rate would be if it was in network but of course the CSR would not give me the info. Is there a way I can obtain it? Doctor does not want to charge the patient the full $100.00 but wanted to write off the amount of the discount rate it would have taken. Hope this makes sense. It is a mess! Anyone have an answer here?
 
You can go back in your records to see what payments prior to 4/1/13 were paid by this carrier for the same CPT code and use that amount to bill the patient.
 
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