Wiki Splitting Global when Dr. goes out of network

[SANEAST]

I have a physician that was seeing several patients and then termed her contract with their insurance company during their OB care.

Would we be able to split the global anterpartum and bill the visits the patient was seen while in network (so the Dr. gets the in network reimbursment) and then bill the visits that the patient was seen as out of network when the patient delivers.

Or do we have to bill globally? My only concern is that if the patient was seen 4 times anterpartum and we bill 59425 in network and then seen 8 times antepartum out of network and we bill 59426 the insurance company will deny it, but then again we do not have a contract.

Has anyone done this before. Dr. is taking payments as is not charging OON bene's or balance billing.

 

[Thouvenel]

I understand the financial side of the concern, but you can't unbundle the procedure. The insurance may not catch it until later, but it is considered insurance fraus for intentionally billing the insurance company that way.