b3ckalano
New
We had a snafu credentialing a new provider at our practice and their official In-Network date was later than we expected. Now we have a handful of sessions where the claims processed as Out-of-Network when we told the patient it would be In-Network. We've tried to get the insurer to honor the original In-Network date, but cannot. Now we're wondering how we charge the patient and stay compliant with the No Surprises Act.
Ideally for us, we would keep the Out-of-Network insurance payments but only charge the patient their In-Network copay/coinsurance. However, this doesn't seem right - because that would mean we didn't collect the copay/coinsurance that the insurer expected us to, and thus throw off the patient's accumulated amounts.
Does that mean we need to void the claims entirely, and only collect the copay/coinsurance from the patient?
Ideally for us, we would keep the Out-of-Network insurance payments but only charge the patient their In-Network copay/coinsurance. However, this doesn't seem right - because that would mean we didn't collect the copay/coinsurance that the insurer expected us to, and thus throw off the patient's accumulated amounts.
Does that mean we need to void the claims entirely, and only collect the copay/coinsurance from the patient?