Wiki Billing Insurance (Fees)

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nutter98

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We recently signed a new contract with one insurance company that gives us an enhanced fee for procedures done in the office. I have always heard that you should bill all insurance the same rate. My question is, if we need to raise our fees because of this enhanced fee, do we raise it for just the one insurance company or across the board?
 
We have one set fee (or charge) for a procedure with different allowables based on our contracted insurance's fee schedule.

Jerri
 
That is how we are currently billing but some of the enhanced fees would increase office procedures by $100 to $400. Do I legally have to bill all the same and just adjust off more for the ones without the enhanced fee or can I just bill the one insurance company more?
 
Many insurance contracts have wording that covers this situation. It boils down to you can't bill them anymore than you would anyone else for the same service.

If you want to increase your rates for the one, you should for everyone else as well.

As far as the legality, I don't know. Ethically it would be wrong to charge some people more because of the type of insurance they have.

Laura, CPC, CEMC
 
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