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   RE: asking payment and NOT billing insurance even if we're contracted
 From: Jeff Huotari
 To: Member Forum
 Posted: 08-07-2017 22:20
 Message: I see it as:

1. You have a contract with the payer, so you have to bill according to the terms of that contract. Whether the patient plans to establish care is not relevant to the contract (unless you have a really atypical contract).
2. He does not have a contract with Medicare, so he does not have a contract with the secondary payer (i.e a payer covering the patient's 20% of the Medicare Part A or B charges). He can bill however he wants, including not submitting anything to a secondary payer.

I have no idea if I'm right; that's just how I see it.

Jeff Huotari, M.D.
BlueSky Health
138 W. Highland Rd., Suite 950
Howell, MI 48843

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------Original Message------

Two different situations both related to collecting payment at the time of service and not billing insurance for a patient visit even though we are contracted with a particular insurance.

It seems like an area of many opinions but no consensus if I'm breaking any rules.
I can't find anything in my actual insurance contracts addressing this.

1. a non-established patient calls and needs an urgent same day appointment (a friend of patient, relation from out of town etc). They do have insurance with whom we contract but aren't planning to establish care with us. Is there anything wrong with us not collecting their insurance information and charging a one time out of pocket fee for the visit?   We provide them with claim information if requested if they want to bill the insurance on their own.

2.  A patient with medicare.  I am contracted with medicare and bill them. My partner is not contracted and cannot bill them. He is a naturopath and given a federal insurance system, they do not recognize his license.  When anyone establishes at our clinic with medicare, they sign a form and it clearly states that for visits with me I bill, but visits with Jonathan, they will have to pay out of pocket.

A patient has  a secondary that Jonathan can bill to.  Are we obligated to do the extra work to bill to that insurance for visits with him or can we still ask a patient to pay for out of pocket? They could of course still submit on their own if they so desire.

I'd also love to hear if you have a creative systems you're using to be able to continue to take insurance for the sake of our patients but make it less onerous within your own system.  That is really all we're trying to do-  find middle ground and be creative to keep it working for us all.

Thanks. Melissa

Melissa Weakland MD
Ballard Neighborhood Doctors
Seattle WA
IMP since 2007

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