My mom has a PPO and went to an out of network specialist for her back. She just got an EOB and her insurance only paid R&C and left her with an additional $700 of bills. My question is this: Do doctors typically write off the difference or is my mom going to see this in her bill? Doctor was paid 1k already. If my mom is responsible for amount over R&C is there anyway to contest with her insurance company?
2006-12-19 06:44:43 · 5 answers · asked by mamatohaley+1 4 in Business & Finance ➔ Insurance
If you do not know what my abbreviations mean than you will not know the answer to my question.
R&C- Reasonable and Customary
EOB - Explanation of Benefits.
We are aware of what the benefits are. I am curious how the doctor handles it
2006-12-19 06:54:09 · update #1
Doctors do not normally waive the balance, especially if they are NOT a "private practice" physician - that would mean, they're an employee, and they don't have the POWER to waive the balance.
If they ARE a private practice physician, you can ask them to waive the balance, but they don't have to.
The only way to contest this with her insurance company, is to read the policy, and see if it says something different from what they are doing. If it says, "we pay 80% of U&C after the deductible is reached" and they are only paying 50%, well, you can contest that!
BTW, most policies use "Usual and Customary", not "Reasonable and Customary", which is why the R&C is confusing some people.
2006-12-20 01:26:35 · answer #1 · answered by Anonymous 7 · 0⤊ 0⤋
It depends. If the doctor agreed to accept in-network payment or the EOB states "patient can not be billed" - then they write off the additional charges. If neither of the two previous instances are applicable here, then, she might get billed, and she can't contest it with the insurance - unless the doctor WAS in network at time of service and was paid incorrectly. (That's the risk one runs with using their out of network benefits.)
IF she gets billed - try negotiating with the doctor's office. Offer them half in cash right away and see if they'll take it as payment in full. Most will - because it's less time and money they have to spend billing you.
2006-12-20 04:48:01 · answer #2 · answered by zippythejessi 7 · 0⤊ 0⤋
I'm not sure what all your abbreviations mean, but I think you are saying she went out of network and the insurance only paid part of the bill. Well, that's how it works. You stay in network or you pay more. Your mom is responsible for any amount charged by the doctor that is not covered by the insurance. This is detailed in her insurance booklets and information. She was aware of this before she chose to go out of network (or she should have read her policy). She pays. Period.
If you got an EOB, then it tells you how much you owe right on the piece of paper.
Yes, doctors write off charges that insurance (and especially medicare/medicaid) won't pay or won't authorize.
2006-12-19 06:49:51 · answer #3 · answered by Phoenix, Wise Guru 7 · 0⤊ 2⤋
I would ask the doctor about their billing policy. Providers usually end up writting off a large portion of bills when they are contracted with the insurance company. So to answer your question they can bill your mother. I doubt they will it is very rare that a provider actually recived 100% of charges billed. Hope this helped.
2006-12-19 08:53:54 · answer #4 · answered by Anonymous · 0⤊ 0⤋
If the plan says it will only pay R&C then that is all it will pay (and that is how most of them are). If your doctor charges more, then you have to pay it. You may be able to negotiate a smaller amount by talking with the doctor, but yes he is going to bill you for the difference.
2006-12-19 08:46:17 · answer #5 · answered by deep5223 4 · 1⤊ 0⤋