Practice Management

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           Does anyone have any firm information on regarding if we are aware the patient has insurance at TOS and the patient has a high deductible and then wishes to be self-pay? In a compliance/guidelines stand point can we do this? We currently do not allow this as it seems to be fraudulent to the patients insurance. Any help would be greatly appreciated!

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Diane Ramirez
Business Office Manager
Radiology and Imaging of South Texas LLP
Corpus Christi TX
361-853-4503
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Nothing fraudulent about it.  You're not deceiving anyone.

The only reasons you would be unable to do this are if your contract with the insurance company prohibits collection prior to claim adjudication (I would always try to negotiate that language out), or if you don't know the allowable amount under the contract to collect (hopefully your contract clearly defines fees).

Of course, you would also need to confirm deductible status in order to collect the correct amount.

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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
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Original Message:
Sent: 03-07-2018 12:03
From: Diane Ramirez
Subject: Self Pay vs. Insurance - High deductible situations

​​
           Does anyone have any firm information on regarding if we are aware the patient has insurance at TOS and the patient has a high deductible and then wishes to be self-pay? In a compliance/guidelines stand point can we do this? We currently do not allow this as it seems to be fraudulent to the patients insurance. Any help would be greatly appreciated!

------------------------------
Diane Ramirez
Business Office Manager
Radiology and Imaging of South Texas LLP
Corpus Christi TX
361-853-4503
------------------------------

​Also consider that the patient may have a right under HIPAA to elect not to share claim information with their insurance carrier.   Our hospital partner interprets HIPAA that way, and introduced a form a few years back that a patient can sign requesting that claim information not be shared with their insurance company, and the patient must then pay cash.

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Theresa Moss
Center for Diagnostic Imaging
Chesterfield MO
(314) 560-1831
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Original Message:
Sent: 03-07-2018 14:23
From: David Smith
Subject: Self Pay vs. Insurance - High deductible situations

Nothing fraudulent about it.  You're not deceiving anyone.

The only reasons you would be unable to do this are if your contract with the insurance company prohibits collection prior to claim adjudication (I would always try to negotiate that language out), or if you don't know the allowable amount under the contract to collect (hopefully your contract clearly defines fees).

Of course, you would also need to confirm deductible status in order to collect the correct amount.

------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387

Original Message:
Sent: 03-07-2018 12:03
From: Diane Ramirez
Subject: Self Pay vs. Insurance - High deductible situations

​​
           Does anyone have any firm information on regarding if we are aware the patient has insurance at TOS and the patient has a high deductible and then wishes to be self-pay? In a compliance/guidelines stand point can we do this? We currently do not allow this as it seems to be fraudulent to the patients insurance. Any help would be greatly appreciated!

------------------------------
Diane Ramirez
Business Office Manager
Radiology and Imaging of South Texas LLP
Corpus Christi TX
361-853-4503
------------------------------

Original Message------

​​
           Does anyone have any firm information on regarding if we are aware the patient has insurance at TOS and the patient has a high deductible and then wishes to be self-pay? In a compliance/guidelines stand point can we do this? We currently do not allow this as it seems to be fraudulent to the patients insurance. Any help would be greatly appreciated!

------------------------------
Diane Ramirez
Business Office Manager
Radiology and Imaging of South Texas LLP
Corpus Christi TX
361-853-4503
------------------------------