Non-Covered Services

 

 HNS Policy  

With few exceptions, non-covered services cannot be billed to HNS contracted payors.

 

Exception: When reporting 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 the services, provided the patient’s health care record includes adequate evidence to support the need to bill the non-covered service to the payor.

 

HNS providers must verify benefits, prior to providing services, to determine if the services or supplies 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.  Please remember that information received when verifying benefits does not supersede information published in the payor’s corporate medical policies.
  

Waivers for Non-Covered Services 

Prior to rendering any non-covered service (or supply), 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.

 

Waivers must include: 

• Practice and/or Provider's name

• Patient's name

• Date waiver obtained

• The specific service or supply recommended

• The cost of the service/supply

• A statement indicating the service is not covered by their health care 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 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 an appropriate signed waiver from the member, which includes all required information, 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 an appropriate waiver was not first obtained.  So please remember to obtain a signed waiver and be sure that it is maintained in the patient’s health care record. 

 

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

 

HNS has created a sample "Non-Covered Services Waiver" that can be customized for use by any HNS Provider.  Click here for the Non-Covered Services Waiver, or access it under "HNS Forms".