patient has a 100.00 deductible which has not been met. his charge at the doctor's office is 225.00. his insurance ia a 70/30 policy. how much
should he pay at time of the visit ?
2007-01-08 15:06:40 · 5 answers · asked by big jeff 1 in Business & Finance ➔ Insurance
$100, plus 30% of the balance.
2007-01-08 17:47:00 · answer #1 · answered by Anonymous 7 · 0⤊ 3⤋
You are allowed to collect the ded and copay up front.
You only HAVE to bill the insurance IF you have a contract with them.
Some who have answered here assume there is a contract in place because they speak of negotiated rates and such. This is not always the case. Therefore, what the pt will end up owing in the end can depend on if you do or don't have a contract with the insurance company in question.
I would collect the $100 deductible and wait on the 30% part. Many insurance carriers have their own fee schedules and having a 70/30 policy does not mean they will pay 70% of what is actually billed they will only pay 70% of their approved amount (an amount a doctor or hospital does not have to accept unless there is a contract). Also, many like to shave some off the top for reasonable and customary - an amount a physician and/or hospital is not required to write off so, the pateint may end up owing more than the actual 30% of the charge.
2007-01-09 03:57:02 · answer #2 · answered by sawftandtender 4 · 0⤊ 1⤋
NOTHING at the time of the visit. The insurance MUST be billed first. The insurance will then tell the provider how much to bill the patient. THEN, the patient pays.
Twofold reason for this - what doctors bill and what insurances pay are two different things. Deductibles are often contracted rate - meaning, if the doctor bills $100, the insurance would pay $45, and that's what they tell the doctor to bill the patient for. The second reason is - if you pay up front, it's harder to track how much goes to the deductible.
2007-01-09 01:43:24 · answer #3 · answered by zippythejessi 7 · 0⤊ 0⤋
None.
The doctor will file a claim with the insurance company. Then you will get notice of how much is covered, which shows their negotiated rate (less than what the Dr. originally billed you). The negotiated rate less the amount covered is what you owe. And that may even be adjusted lower when the Dr. generates the final bill.
2007-01-08 16:05:51 · answer #4 · answered by g g 3 · 1⤊ 1⤋
$137.50. Paying the 100 deductable leaving $125 to be paid by the insurance co at 70/30 or $87.50 for the insurance co. and another $37.50 for you.
2007-01-08 15:19:05 · answer #5 · answered by sirbuzz8 2 · 1⤊ 2⤋