Wiki HMO billing

[ded1982]

I work at a small urgent care facility in Illinois. Our clinic does not accept HMOs insurance and there is a BCBS policy that has the letter prefix XOU which processes as an HMO. I spoke to a random person in billing who mentioned that she knows there is a way to get around billing this insurance so that they will process it and we can receive payment, something to do with services not covered and deductible not met but that was all she knew or would tell me. Does anyone know anything about this or have any clue as to what she was referring to? Any help would be appreciated so we don't have to keep turning these patients away without making them pay out of their pockets.

 

[BMICHAUN]

You would have to verify if this patient have a POS plan were they can use there out of network benefits and have the claim processed and most likely the the allowed amount will be applied to patient deductible/coins.