out-of-network

  1. S

    Wiki Billing with primary and secondary insurances

    Looking to verify the proper patient responsibility to bill them in the following scenario as well as the proper rationale. Primary insurance is a high deductible plan through BCBS and allows $3000.00 to the patient's deductible for a patient's surgery on the $5000.00 billed charges. We do not...
    • sharonc2222
    • Thread
    • balance billing medicare secondary out of network out-of-network patient responsibility
    • Replies: 10
    • Forum: Billing/Reimbursement
  2. R

    Wiki Reference-Based Pricing with self-funded plans

    Recently there has been a lot of discussion in the self-funded world about Reference-Based Pricing (RBP) and the vendors offering this solution to help these plans save money. The model used in this context advertises an "open network" (go to any provider) then provides the employer with a...
  3. J

    Wiki Modifier ET

    Hello everyone. Currently our office is out-of-network with UPMC. Our physician is plastics/hand specialist and is on-call at our local hospital. He often gets called for UPMC patients. Recently, he has found modifier ET and wants to affix it to all his codes because he thinks he should be...
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