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Thread: Balance Billing

  1. #1

    Default Balance Billing

    AAPC: Back to School
    I know that this is not direct coding question, but I am curious if anyone is familiar with Georgia's policy on balance billing for non-government payors, and non networked providers. I am curious to know if other providers are balance billing for amounts that the payer is considering to be aboove the maximum allowable amount?
    Example: Patient is serviced by a non-par provider and charged $26.00

    Cigna allows $17.52 but applies to deductible and adjusts $8.48 as over max. allowable

    Cigna considered pt. responsibility to be $17.52. Do you bill the patient the $8.48 as well?

    Your thoughts.

  2. #2


    I have done billing for about 13 years and if you are non par you can charge the patient the total amount. Even if the insurance company says xyz is over the allowable. It has been my experience that every office is different and some offices elect to NOT charge the patient the additional amount and reduce down to the allowable, or give some other form of discount.


  3. #3
    Join Date
    Apr 2007
    Omaha, Nebraska


    I, too, have been in the medical billing/insurance industry for over 25 years. 18 of those years were spent working for a major insurance carrier. If you're concerned about this, I would double check with your state insurance department, however, I agree with Stephanie - if your practice is non-participating with the insurance company, you are not required to write-off the amounts over and above the approved/allowed amount; holding the patient responsible is okay. Of course, the final decision is always that of the practice management - but, legally you can require patients to pay those over allowable dollars.
    Carolyn Kohler, CPC
    Omaha, NE

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