The fees are the same for everyone. HOWEVER ... the adjustments vary based on contracts and written policies in place.
For example let's say all following patients have the same service/procedure for which the fee is $100
Patient A has commercial insurance which pays at 80% of billed fee. (our adjustment is $20)
Patient B has commercial HMO (we are in plan) which pays at 80% of ALLOWABLE .. in this case $75 allowable (our adjustment is $25)
Patient C has Medicaid which pays $35 for this procedure (our adjustment is $65)
Patient D is self pay without insurance, which per our written policy we automatically discount by 10% (adjust is $10)
Patiend E is self pay without insurance and had filed financial hardship paperwork; qualifies for 100% charity care (adjustment is $100)
You get the idea...
F Tessa Bartels, CPC, CEMC
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