Results 1 to 3 of 3

Insurance Co Settlements

  1. #1
    Long Island/New York
    Default Insurance Co Settlements
    Medical Coding Books
    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
    Long Island/New York
    Thank you..

Similar Threads

  1. When to bill Vision insurance v. Medical insurance
    By SarahCaldwell in forum Ophthalmology/Optometry
    Replies: 3
    Last Post: 04-29-2015, 09:17 AM
  2. E/O insurance
    By dragonflye in forum Employment General Discussion
    Replies: 1
    Last Post: 09-17-2009, 03:20 PM
  3. Insurance Only
    By in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 11-05-2008, 09:35 AM
  4. Billing Auto Insurance vs Private Insurance
    By kathymoon in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 08-08-2008, 07:47 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.