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Thread: Insurance Co Settlements

  1. #1
    Join Date
    Apr 2007
    Long Island/New York

    Default Insurance Co Settlements

    AAPC: Back to School
    We have a pediatric surgeon who is out-of-network with a few ins co's. He did a 13-level fusion (22804) for an ins co. Our billed charges was a little over $50,000. The ins co offered $34,000 - which I thought was good.

    My question is what is the best way, if any, to calculate an offer of a surgery from an OON (or even sometimes In-Network) ins co? Would a minimum % of billed charges be a good idea? Curious if anyone has a policy on this type of scenario. Thanks.

  2. #2


    I do ASC billing for spine cases. We accept reductions on a case by case. I will accept 10% reduction if the deductible has been met and if benefits are at least 70/30 or above. If the OOP has been met we accept 15% reduction. We always ask for the actual check amount which is definately something they can obtain for you. Hope this helps.

  3. #3
    Join Date
    Apr 2007
    Long Island/New York


    Thank you..

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