I work in a medical office and recently was challenged with the following scenarios: 1. Adjustment of patient's Co-insurance, when the provider is not participating in insurance Network? 2. Adjustment and/or write-off of Medicare co-insurance, with Medi-Cal being a secondary plan (provider is participating with Medicare, but not Medi-Cal) Please help!
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What do you mean by adjust? Do you mean write-off? I work for an out-of-network provider and we bill the patient for all amounts not covered by the insurance company. If the total charge is $250 and insurance pays $160, we bill the patient for $90. If we were in-network, we would write off the $90. If you're asking if you're allowed to write-off that $90 as an out-of-network provider, that is essentially up to the doctor. It can be considered a "Charity write-off." We do this with many of our patients who need financial assistance. It is not against any rules since we are not bound by any insurance contracts. I don't know anything regarding Medicare/Medi-Cal as I do not deal with those at all.
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