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Thread: Non par reimbursement - ANY NON-PAR TRAUMA BILLERS

  1. #1

    Default Non par reimbursement - ANY NON-PAR TRAUMA BILLERS

    AAPC: Back to School
    Billing for non-par trauma doc's for professional services. Kaiser paid for a pt in full for my billied 99291 but not in full for my 99292 as they stated paid by customary and resonable fee and noted an adjustment.

    Anyone billing for non-par. My understanding was they should be paid in full as they are not participating and under no contract. I don't know how to know what the reasonable/customary fee is.... Can I appeal ?

    Thanks for your advice

  2. #2
    Join Date
    Apr 2007
    Hartford, CT


    If you are non-par the insurance company has no obligation to pay anything, unless the patient has out of network benefits on their policy. If they do pay, they will only pay what they consider customary and reasonable. At the same time, as a non-par physician. your doctor is under no obligation to accept their customary and reasonable as payment in full and can then balance bill the patient for the difference.

  3. #3


    Hmm so many conflicting responses on the Net. Yes you can balance bill, no you cannot because it is an Emergency and the patient could not decide where they were going to be seen....frustrating !

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