Non-covered services

HNS providers must verify benefits prior to providing services to determine of the services planned are covered chiropractic benefits under a patient’s health care plan. (When verifying benefits, providers should always ask if the planned services are covered when provided by a chiropractic physician.)

In addition to verifying benefits, with respect to non-covered services, HNS providers must comply with any applicable payor corporate medical policies.  For easy reference, both BCBSNC and CIGNA HealthCare Corporate Medical Policies are included in this section of the HNS website.

Please remember that information received when verifying benefits does not supersede information published in the payor’s corporate medical policies.

For out-of-state plans, when the provider does not have access to specific corporate medical policies, the provider should utilize the HNS Verification of Benefits Form, and follow the directives provided by the home plan when verifying benefits.

In general, non-covered services cannot be billed to a HNS contracted payor. 

Exception: When you need to report a non-covered service in order to obtain a denial to use for coordination of benefits and/or if your patient needs to obtain a denial from a payor for reimbursement under a flexible spending account, HSA/HRA account, those services can be reported to a payor that does not cover these services, provided the patient’s health care record includes adequate evidence to support the need to bill the non-covered service to the payor.

Waivers for Non-Covered Services

Prior to rendering any non-covered service, HNS providers must first obtain an executed, appropriate waiver from the patient.  This waiver cannot be a generic waiver but must be specific to the actual procedure or service to be rendered to each individual member.  All waivers must be maintained in the patient’s health care record.

Such waivers must include:

• Practice and/or Provider’s Name
• Patient’s name
• Date waiver obtained
• The specific service the provider recommends
• The cost of the service
• A statement indicating the service is not covered by their health plan
• A statement that indicates, by signing such a waiver, the member agrees to the service or procedure and also agrees to pay for the service or procedure
• The signature of the adult patient, or parent or legal guardian if the patient is a minor

HNS providers cannot bill the patient for any non-covered services provided unless they have first obtained the appropriate signed waiver and the waiver is on file in the patient’s health care record.

Providers who fail to obtain a signed waiver from the member prior to the rendering of a

non-covered service, cannot bill the patient for those services. Additionally, providers will be required to refund any monies collected from the patient for any non-covered services provided for which a signed waiver was not first obtained. So please remember to obtain a signed waiver and be sure that it is maintained in the patient’s medical record!

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 HNS providers.