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OON questions

1. If there is no co-pay/coinsurance assigned to a line of service, can the patient still be billed a co-pay/coinsurance for an out of network provider?

2. If the out of network provider is not going to be submitting claims, but the patient’s insurance requires prior authorizations, is it still on the provider to acquire authorization?

Filed under: Billing

1 answer • 4 years ago

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Jean Claude AKARIKUMUTIMA, 6+ years of experience in copywriting. answered:

If there is no co-pay or coinsurance assigned to a line of service, it is unlikely that the patient would be billed a co-pay or coinsurance for an out-of-network provider. However, it is important to check the patient's insurance policy and any agreements between the insurance company and the out-of-network provider to confirm whether or not the patient will be responsible for additional charges.

If the out-of-network provider is not going to be submitting claims, it is likely that the responsibility for acquiring prior authorizations would fall on the patient or their representative. However, it is important to check the patient's insurance policy and any agreements between the insurance company and the out-of-network provider to confirm who is responsible for acquiring authorizations. Additionally, it is also important to check if the insurance company of the patient have any network providers which can be used instead of the out-of-network provider.

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