Wiki Balance Billing when a gap/out of network waiver is approved?

[2thgirl]

Hello. Can someone help me? Our office is out of network with a few insurance companies which causes us to request a Gap Exception/Waiver , which authorizes us to be in network for a certain procedure they need. My question is, are we able to balance bill after insurance pays? The explanation of benefits usually states the patient responsibility is zero or just the copay, although I am being told I can tell the insurance company we want to balance bill them when requesting the gap? I thought the reason to get the waiver was to minimize patient responsibility?

 

[CBLENNIE]

Balance billing

What state are you in? Here in Idaho if an OON order accept a referral for a patient in a managed care plan, Idaho State code says the accepting provider cannot balance Bill the patient for any amounts denied as in excess of the insurer's maximum allowance.

However, the insurer cannot enforce the statute, so the charges in excess of the maximum allowance show noncovered on the EOB. The provider is expected to write the charges off on the patient's account.