COVERED SERVICES

Claims for all covered services provided to members whose health care plans contract with HNS must be filed to HNS.

Exception: If a patient requests that claims are not to be filed to th health care plan, providers must comply with this request.  However, such requests may only be honored if the request is properly documented in the patient's health care record and if the patient has paid in full at the time of service.

The fact that the physician may prescribe, order, recommend or provide a service or supply, does not, of itself, make it a covered service/supply or medically necessary under a member's benefit plan, even though it may not be specifically listed as an exclusion under the member's benefit plan.

Covered services provided and billed through HNS should be delivered in the most  efffective and cost-efficient manner.  

Note:

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.