Results 1 to 3 of 3

Balance Billing

  1. Default Balance Billing
    Medical Coding Books
    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. Default
    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
    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

Similar Threads

  1. ABN/Balance Billing
    By y_anderson1 in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 12-11-2014, 01:09 PM
  2. balance billing
    By ASH527 in forum Billing/Reimbursement
    Replies: 1
    Last Post: 10-03-2014, 08:18 AM
  3. Balance Billing Past Timely
    By sparkles1077 in forum Billing/Reimbursement
    Replies: 6
    Last Post: 09-26-2014, 07:46 AM
  4. Balance Billing Patient
    By lpyrtle in forum Compliance General Discussion
    Replies: 1
    Last Post: 03-30-2011, 11:39 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.