Wiki Medicare Replacement wants to Self Pay

[mah3434]

We have a patient that is unable to get approved for a procedure, she wants to proceed with the procedure and pay out of pocket. Her insurance is a Medicare replacement policy HMO.

Can we not bill her insurance since we are in-network? Do we allow her to pay according to Medicare allowable or our regular self-pay rates?

 

[syllingk]

Have them sign an ABN.

 

[xlbctso]

Not only have them sign the ABN but bill the insurer with the appropriate modifier so you can have the denial and bill the member.

 

[barbacasec]

I agree with this one. you still want to bill the insurance- and have the ABN so when they insurance denies you can bill the patient. but you need to bill the insurance is you are participating with them.