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Patient Balance need help?

  1. #1
    Question Patient Balance need help?
    Medical Coding Books
    I work for an Orthopedic Surgeon and he is out of network. This is the scenario and I need advice?
    The doctor assisted with a surgery and we were paid, but since we do not par patient had a responsibility; however the dr told me to adjust. I sent a bill to the patient and patient called the primary surgeon to complain they had received a bill and the Dr called my Dr to complain.

    I know we are to send the patient a bill because it is required by law, but I do not have any information to back up my explanation to the Dr. I need help????
    Ivonne Atanacio CPC,CPB,CPMA,CPC-I

  2. Default
    Quote Originally Posted by ivonneatanacio View Post
    I work for an Orthopedic Surgeon and he is out of network. This is the scenario and I need advice?
    The doctor assisted with a surgery and we were paid, but since we do not par patient had a responsibility; however the dr told me to adjust. I sent a bill to the patient and patient called the primary surgeon to complain they had received a bill and the Dr called my Dr to complain.

    I know we are to send the patient a bill because it is required by law, but I do not have any information to back up my explanation to the Dr. I need help????
    Hmm, well since your Dr is non-participating with this carrier and not bound by any contract with them...I believe you can balance bill the patient OR write off as you wish. Not sure what "required by law" you're referring to, whether it's a state law or not. If you are non-participating with a carrier and they send you an EOB saying this $ amount is patient's responsiblity....that is how much they're allowing you to make patient respons...but since you're not contracted with them you CAN write all or a percentage of that off if your Dr wants. Just make sure to document carefully what the circumstance is...charity or coordination with other surgeon, or whatever.
    Jenna

  3. #3
    Location
    Jamaica, NY
    Posts
    55
    Default
    We are an Anesthesia group, and experience this all the time. Depending on the insurance carrier, you or the patient can try to appeal for more money based on the fact that the patient did not have a choicein the matter. It was not as though the patient could choose an in network asst. surgeon at the time. Legally you can balance bill, since you are non par. But if you don't want to ruffle feathers with the primary surgeon, lighten up the wording on the bill to say, "we have billed your insurance,we will need you to contact your insurance carrier" or something to that effect.

    Ellie-Ann Marchese, CCS-P, CANPC

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