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Balance Billing

BCBSNC Corporate Medical Policy (CMP)

     - Chiropractic

     - DME Vendors

     - EMG/NERVE 

       CONDUCTION

     - VAD

     - Orthotics

     - Spinal Manipulation

       under Anesthesia

Chief Complaint

CIGNA HealthCare Corporate Medical Policy (CMP)

Claims/HNS Payment Protocols

Clinical Examinations/ Re-Examinations

Chiropractic Manipulative Therapies

Coding (ICD, CPT, HCPCS)

Confidentiality of Health Care Records

Co-payment/Co-insurance/Deductibles

Covered Services

Diagnostic Impression

DME Services

Documentation Requirements for the Healthcare Record

Electrodes

Evaluation & Management Services (E/M)

Financial Hardship

Frequency of Visits

Group Practices

HNS Credentialing Policies & Procedures

Informed Consent

Insurance ID Cards

Locum Tenens Billing

Maintenance & Supportive Care

Medical Necessity

Modalities/Therapies

NC Board of Examiners Guidelines

Nerve Conduction/EMG

Non-Covered Services

Notifications to HNS

Patient Education & Instruction

Prescribing Drugs

Quality Improvement, Utilization Management (UM)

Radiology

Refunds/Overpayments

Requests for Patient Records

Retention of Records

Treatment of Family Members

Treatment Plans

Verifying Benefits

Waiving Co-pays, Deductibles & Co-Insurance

balance billing

 

Balance Billing is defined for this policy as the practice of billing a member in excess of  the allowable or contracted rate for all charges not paid for by the Member's insurance plan for covered services rendered.

While providers can and should collect all applicable copayments, co-insurance and deductibles, providers cannot "balance bill' the patient for the difference between the providers usual and customary charge and the contracted allowable amount.

The signing of a "waiver" does not allow a provider to "balance bill" a patient for covered services provided

"Balance billing" should not be confused with billing for services that are not covered under the member's plan. All network providers can provide and collect their usual and customary fee for any non-covered services, provided they have first obtained a signed waiver from the member. 

Please remember that the waiver cannot be generic and must specifically state the service/supply recommended, as well as the costs.  All waivers must be maintained in the member's health care record.  Please visit the HNS Forms section of this website for HNS template "waivers" that can be customized for use by any HNS provider.

 

 

 

 

 


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