 Posted: Mon Nov 30, 2009 9:44 pm Post subject: |
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Technically the coinsurance is not being lowered….. Normally the insurance company keeps track of the coinsurance that the insured pays (both in an out of network) as there are maxs on both in and out of network. So in this case the insurance company is paying at 50% and the insured’s coinsurance is 50% (in the eyes of the insurance company)
As for the insured, they are paying less since the doctor is waiving the balance of the bill or a portion of the bill as someone stated above.
It’s just semantics, but bottom line the insured is paying less. Lab companies, LabCorp and Quest do it all the time for low balances (couple bucks). It’s not worth their time billing for small amounts. In this case the doctor is not billing the balance and is taking the loss to be nice.
Even if the doctor inflates his bill, it should not matter as also stated below your company is only going to pay 50% of usual and customary.... So if usual and customary is $150. they are going to pay $75.00. If the doctor charges 1 million they are only going to pay $75.
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Dasfuk
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