I struggle to know when a payer is going to apply a copay versus coinsurance. Which can make it hard to give an accurate estimate. Running benefits on the payer will often show a copay and coinsurance but how do I know which applies to which CPT code? If they're going to only pay a copay for the visit or coinsurance for the allowed amount? I hope that makes sense..
Thank you for taking the time to show us these examples of the calculation process. I am currently studying for my CPB exam and this really helps. This is the process where I seem to get lost. So again, thanks and I would love to see some more of these. I love your channel. Keep up the great work.
You're welcome! Insurance can be really confusing, for both patients and billers alike. That's why we made a course to help people better understand US Health Insurance: ips-s-school-8c86.thinkific.com/courses/Intro-to-US-Health-Insurance
Right now lots of billing fraud occurring mostly by hospitals will over bill same lab or increase OP visit to more than 75%. Thus the patient has to pay if not aware.
Thanks for your comment! Yes, it's quite unforntunate that patients do not always know when to question as the statements can lack detail or be confusing.
Thank you for these videos. It is so crazy that I have to wait to hope to get paid by insurance and then if the patient needs to pay then I have to wait for that too.
thank yu it makes sense and yu explained it so that a patient inquiring about bill would understand. im looking into taking course and get certified for medical biller and get back into what i loved doing and did 14 yrs of medical admin
If the provider is in-network (contracted) with the insurance. It gets written off as a contractual adjustment. They cannot bill the patient. If they are not in-network the practice/provider can balance bill the patient for the remaining balance.
When do you check for a coinsurance responsibility? Before the patient gets the service (so they pay it at the beginning ?) or do you process the insurance and then charge the patient ?…if we don’t know what the allowed amount I’m he saying it’s after we get the EOB
Thank you for your comment! There’s not really a one size fits all when it comes to coinsurance calculations. It would depend upon the specialty of your practice, and how often, in advance of the patient going back for care, you know exactly what the provider is intending to do with the patient. If it is an unknown until after the patient has been care for then you may have to wait until check out.
I live in the State of Washington. It has Regence and Premera. Since they are both associated with Blue Cross Blue Shield what is the difference between the two? Any advantage of one over the other? Love these Vids!
Yay! So happy you are finding value! They are two separate companies that license BC/BS and each "own" different areas of Washington state. In addition to Washington St. Premera also services Alaska and Regence also services areas of Idahos. Other than that they are both BCBS carriers and will have competitive plans but they are not permitted to sell plan with Zips assigned to the other companies region. I hope that makes sense.
Hi, new subscriber here. I have an interview at 4pm today for a charge entry specialist. I have no idea what to do or say. Thanks for explaining copay and co ins. I had this question asked in an interview two weeks ago.
Yes, quite often especically in practices especially where two separate benefits could apply. For example, there may be a copay for the ortho exams (E&M) and a coinsurance for physical therapy. Does that help?
maam it would be easier to understand if u can show the calculation on the side for both blue and green examples that u have shared. would wait for ur reply
Thank you for clarifying this up. I do have an additional issue when it comes to seeing a disputed amount. I'm not weather to bill the patient or write it off if no secondary insurance. I work in a chiropractic office now and I multitask all day and it has gotten me in trouble. Yes I had left me not being able to ask the same question beyond two.
I'd be very cautious with writing it off, if it is anything other than a CO45 (contractual adjustment), without prior approval from your boss. Any denial is going to come with a code on the EOB, and if your boss says you can write it off then you can go ahead and save it for reference in the future.
