Wiki Insurance vs Self-pay

[chavera]

Hello,

I need to see if anyone can clarify a problem we are having with a yellow fever vaccine. We have people in which they are not established with us who are needing to get the yellow fever vaccine. We are a yello fever vaccine center in which per our doctor he doesn't want us to bill their insurance since they do not pay what the cost of the vaccine is. Don't we have to bill the insurance if the patient has it? Also, one patient self-payed and their insurance called and asked why we didn't bill the insurance and we ended up sending them the claim. Now the insurance paid but they did not pay atleast what the cost of the vaccine is so now the doctor is not going to refund the patient. Is this something he can legally do?

Thanks

 

[mrspfcsmith]

You should appeal the claim.
Send them a copy of the EOB with the invoice showing how much you paid for the vaccine.

 

[lbrown1]

If your doctor participates with the insurance, he should be billing the insurance company. He will be paid the contracted rate for the vaccine. If he feels that reimbursement is not adequate, he can speak with the Provider Contracting department. If the vaccine is covered in any way by the patient's insurance, it should be submitted. Whether the patient is to be balance billed will depend on the insurance and your doctor's participation status.
In the example you gave, the patient can reach out to his insurer and request assistance with the refund.
I hope this helps.