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Medical Billing Would and insurance company drop a doctor if he decided to drop his hourly fee for 1 patient? |
I was asked recently if a doctor had a $150 hourly fee for a POS service and decide to lower it for 1 patient "in need" to say $30 what would happen. I believe that his credentialed Insurance companies would drop him. Can someone varify what would happen? Dude, this entire forum if full of misinformation & contradiction. Here's what I know.... Most doctor's insurance contracts state they have to bill their 'cash' patients the same amount the bill their 'insurance' patients. Changing your billed amount or failing to collect copays & deductibles is call FEE FORGIVING. This is considered fraud in most circumstances. If a docs contracts & private pay fee schedules are on a sliding scale; that's fine. As long as it slides the same way for everyone who qualifies. Yes... They can lose their insurance contracts. Yes, it can be reported to the BBB & the state board of medical examiners. Source(s): wk in health insurance & provider contracting/credentialing for 10+ years. If the prospective patient isn't covered by any of the insurers with which the doctor participates, it doesn't matter to the insurers what he or she charges this patient. All insurers care about is what THEY have to pay for a particular doctor's services. So no, the doctor cannot be dropped for lowering his or her fee for a needy patient who has no insurance. Yes, they get dropped. Especially if they take Medicare - they have their pre-negotiated charge (and it's a flat fee, btw, not an hourly rate) per service. You HAVE to charge that flat fee for EVERY patient with that insurance, or you're in violation of your contract with that insurance company, and can get cancelled. With Medicare, I believe you're also open to legal prosecution - which means jail and fines. agent, 21+ years You don't really say - is the "patient in need" covered by insurance? If they are, there shouldn't be any "need" for the doctor to adjust his fees. But if the patient doesn't have insurance coverage, the doctor most certainly CAN adjust his fee to help out the patient. There wouldn't be any consequence, because the patient isn't affiliated with an insurance plan, and the doctor can charge what he chooses. actually the insurance company would be happy that he dropped his fee so they don't have to pay so much!! I've processed claims for Wellpoint (anthem) blue cross and blue shield for almost 9 years now. if the provider is charging less than the negotiated rate then we pay a portion (depending on the policy 80%,70% etc..) of the billed charges/ negotiated rate (which ever is less) which would be less for us to pay and we'd be happy so to answer your question no they wouldn't get dropped!! |
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