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Can a provider bill the patient though he is contracted with local blue cross if patient has an out of state plan?
Wiki User
∙ 15y ago
Providers who are not "in network" for the particular version of Blue Cross cannot be sure of being reimbursed for treatment they provide. Thus, they must bill the patient, who then takes on the responsibility of dealing with the insurance. Most providers will assist with this, if asked.
This is an issue with the insurance company, not with the provider.
Wiki User
∙ 15y ago
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What is Blue cross blue shield of Georgia timely filing limit?
Actually it depends on the provider's contract with blue cross. Usually it will be 90 days from the date of service for contracted providers, but i have seen up to 180 days as well
If a medical claim is denied because the provider did not file in time is the patient responsible for payment?
Check out this page where Medicare talks about providers being responsible for billing errors if it's their fault http://www.cms.hhs.gov/manuals/13_int/a3700.asp CA Civil Code # 3517. No one can take advantage of his own wrong. 3520. No one should suffer by the act of another. 3526. No man is responsible for that which no man can control. 3529. That which ought to have been done is to be regarded as done, in favor of him to whom, and against him from whom, performance is due. 3533. The law disregards trifles. I would say no. I'm looking though for the documentation. Here's what I have so far.... Q52. How do my PPO benefits work? A52. We have established a network of "Participating Providers". These providers are called "participating" because they have agreed to participate in our preferred provider organization program (PPO). . Receiving services from the Blue Cross PPO Provider network can substantially reduce your out-of-pocket costs. These lower costs are due to negotiated rates that Blue Cross PPO Providers have agreed to accept. These providers SHOULD file claims to Blue Cross for our members, then bill you for the remaining portion of their eligible charges. http://www.bluecrossca.com/pdf/faq/sg_member_faqs_ppo_plans_123002.pdf For more info see www.SteveShorr.com I checked with upper management at Blue Cross - here's their answer Claims submitted by Participating providers after their contractual timely filing period are denied as a provider discount amount. The member is not responsible for these services. There may be instances where a provider does bill the patient for this denial in error. When this occurs, the patient should either contact the provider and remind them this is a provider discount based on the EOB they received from Blue Cross or contact us directly and advise the provider is attempting to bill the member. In the later situation, we will then work with the provider to resolve the matter. No the patient can not be responsible . It should be the providers writeoff.
What are the pros and cons of Blue Cross Blue Shield?
why would a provider not want to accept blue cross blue shield
What is Pacific Blue Cross a provider for?
Pacific Blue Cross is a provider of health care services in British Columbia, Canada. They offer health care plans for individuals, families as well as small to medium businesses.
What is provider level CPR?
Provider is not a type or level of CPR. It is any institution that enters into a contract with the American Red Cross (possibly AHA; I am not sure). The CPR that the provider teaches could be lay or professional.
Do you cross match platelets?
Normally not necessary. do for immune compromise patient
When doing a stem cell transplant and they cross match a patient what does the donor have to match with the patient in order to donate?
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What is private insurance?
Private medical insurance is medical insurance that is purchased directly through a provider and not through the state. For example Blue Cross Blue Shield is a private medical insurance provider.
What is private medical insurance?
Private medical insurance is medical insurance that is purchased directly through a provider and not through the state. For example Blue Cross Blue Shield is a private medical insurance provider.
How is blood transfusion made?
A blood transfusion - is giving a patient a quantity of blood to replace any that's been lost though an accident or injury. A small sample of the patient's blood is analysed to determine the blood group & type. This is 'cross-matched' with blood of the same type stored at the hospital. A unit (or 'bag') of blood is hung above the patient from a metal stand, and a needle leading from the bag is inserted into a vein in the patient. A combination of gravity, and the patient's heartbeat drains the blood from the bag into the body. The bag is replaced when empty or the donation is stopped once the patient's blood pressure returns to normal.
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A circle with a cross though it on clothes means do not dry clean. If there is a triangle with a cross it means do not use bleach.
What is the purpose of mental status examination?
The purpose of a mental status examination is to assess and evaluate a person's cognitive, emotional, and behavioral functioning. It helps clinicians gather information about a person's mental health, including their mood, thoughts, perceptions, memory, and overall mental state, to aid in diagnosis and treatment planning.
