Wiki Providing HICFA forms for out-of-network insurances

[CRWKKW]

If we provide a HICFA form, instead of directly billing out-of-network insurance providers, what price to we 1) charge the patient; 2) print on the HICFA form? We are a non-profit and offer a sliding scale. If someone comes to us with out-of-state insurance and takes advantage of our sliding fees, do we put the reduced amount they paid onto the HICFA form or do we print the form with the full insurance price we would charge?