Loading ...
Sorry, an error occurred while loading the content.

Marketing Follow-Up

Expand Messages
  • Marcus Washington
    Would like to receive some suggestions when doing following up on brochures sent out to prospective clients. After you introduce yourself & tell the client(s)
    Message 1 of 25 , Dec 2, 2007
    • 0 Attachment
      Would like to receive some suggestions when doing following up on
      brochures sent out to prospective clients. After you introduce
      yourself & tell the client(s) you recently sent them a brochure
      regarding your medical billing business, I'm not sure what else do
      say. The goal is to obtain an appointment with the perspective client
      (s).

      Thanks in advance.

      MW
    • ejoktan
      I would appreciate if you could start making cold calls and fix an appointment for meeting.
      Message 2 of 25 , Dec 3, 2007
      • 0 Attachment
        I would appreciate if you could start making cold calls and fix an
        appointment for meeting.

        --- In MedicalBillers@yahoogroups.com, "Marcus Washington"
        <mwash419@...> wrote:
        >
        > Would like to receive some suggestions when doing following up on
        > brochures sent out to prospective clients. After you introduce
        > yourself & tell the client(s) you recently sent them a brochure
        > regarding your medical billing business, I'm not sure what else do
        > say. The goal is to obtain an appointment with the perspective client
        > (s).
        >
        > Thanks in advance.
        >
        > MW
        >
      • Lin
        I always had success in following up in person with a resume actually. Even though I was representing myself as a business I still felt my resume spoke for
        Message 3 of 25 , Dec 3, 2007
        • 0 Attachment
          I always had success in following up in person with a resume actually. Even
          though I was representing myself as a business I still felt my resume spoke
          for itself and was a great selling point. I've also made follow-up calls to
          get permission to fax my resume over which led to getting a few clients as
          well as it still gets me a lot of consulting jobs.





          Linda Walker

          Practice Managers Resource & Networking Community
          <http://www.billerswebsite.com> http://www.billerswebsite.com
          A division of K&L Media, LLC
          <http://www.klmediallc.com> http://www.klmediallc.com

          Website Design & Management for the Medical Services Industry





          From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
          On Behalf Of ejoktan
          Sent: Monday, December 03, 2007 3:59 PM
          To: MedicalBillers@yahoogroups.com
          Subject: [MedicalBillers] Re: Marketing Follow-Up



          I would appreciate if you could start making cold calls and fix an
          appointment for meeting.

          --- In MedicalBillers@yahoogroups.com
          <mailto:MedicalBillers%40yahoogroups.com> , "Marcus Washington"
          <mwash419@...> wrote:
          >
          > Would like to receive some suggestions when doing following up on
          > brochures sent out to prospective clients. After you introduce
          > yourself & tell the client(s) you recently sent them a brochure
          > regarding your medical billing business, I'm not sure what else do
          > say. The goal is to obtain an appointment with the perspective client
          > (s).
          >
          > Thanks in advance.
          >
          > MW
          >





          [Non-text portions of this message have been removed]
        • Joktan Edison
          Could anyone help me on BCBS FL Fee Schedule. I would appreciate your help!!!!
          Message 4 of 25 , Dec 5, 2007
          • 0 Attachment
            Could anyone help me on BCBS FL Fee Schedule. I would
            appreciate your help!!!!







            ____________________________________________________________________________________
            Never miss a thing. Make Yahoo your home page.
            http://www.yahoo.com/r/hs
          • JOSETTE THOMAS SYLVAN
            WHAT DO YOU NEED JOKTAN? ... From: Joktan Edison To: MedicalBillers@yahoogroups.com Sent:
            Message 5 of 25 , Dec 5, 2007
            • 0 Attachment
              WHAT DO YOU NEED JOKTAN?
              ----- Original Message -----
              From: Joktan Edison<mailto:ejoktan@...>
              To: MedicalBillers@yahoogroups.com<mailto:MedicalBillers@yahoogroups.com>
              Sent: Wednesday, December 05, 2007 3:08 PM
              Subject: [MedicalBillers] BCBS FL Fee Schedule


              Could anyone help me on BCBS FL Fee Schedule. I would
              appreciate your help!!!!

              __________________________________________________________
              Never miss a thing. Make Yahoo your home page.
              http://www.yahoo.com/r/hs<http://www.yahoo.com/r/hs>




              [Non-text portions of this message have been removed]
            • Joktan Edison
              I need the fee schedule for BCBS FL insurance. ... MedicalBillers@yahoogroups.com ...
              Message 6 of 25 , Dec 5, 2007
              • 0 Attachment
                I need the fee schedule for BCBS FL insurance.


                --- JOSETTE THOMAS SYLVAN <abcmdbiller123_55@...>
                wrote:

                > WHAT DO YOU NEED JOKTAN?
                > ----- Original Message -----
                > From: Joktan Edison<mailto:ejoktan@...>
                > To:
                >
                MedicalBillers@yahoogroups.com<mailto:MedicalBillers@yahoogroups.com>
                >
                > Sent: Wednesday, December 05, 2007 3:08 PM
                > Subject: [MedicalBillers] BCBS FL Fee Schedule
                >
                >
                > Could anyone help me on BCBS FL Fee Schedule. I
                > would
                > appreciate your help!!!!
                >
                >
                >
                __________________________________________________________
                > Never miss a thing. Make Yahoo your home page.
                >
                > http://www.yahoo.com/r/hs<http://www.yahoo.com/r/hs>
                >
                >
                >
                >
                > [Non-text portions of this message have been
                > removed]
                >
                >






                ____________________________________________________________________________________
                Be a better friend, newshound, and
                know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ
              • debbie brosnan
                Tell us whats up??? Joktan I havent forgotten you about the appeals letter. Having problems putting my hands on one. I have letters for just about
                Message 7 of 25 , Dec 5, 2007
                • 0 Attachment
                  Tell us whats up??? Joktan I havent forgotten you about the appeals letter. Having problems putting my hands on one. I have letters for just about everything but timely filing.

                  Joktan Edison <ejoktan@...> wrote: Could anyone help me on BCBS FL Fee Schedule. I would
                  appreciate your help!!!!

                  __________________________________________________________
                  Never miss a thing. Make Yahoo your home page.
                  http://www.yahoo.com/r/hs





                  [Non-text portions of this message have been removed]
                • Joktan Edison
                  Hey Debbie, how are you doing??? I m looking forward to get the fee schedule for BCBS FL. Do we get this online???? ...
                  Message 8 of 25 , Dec 5, 2007
                  • 0 Attachment
                    Hey Debbie, how are you doing???

                    I'm looking forward to get the fee schedule for BCBS
                    FL. Do we get this online????

                    --- debbie brosnan <thebiller_2000@...> wrote:

                    > Tell us whats up??? Joktan I havent forgotten you
                    > about the appeals letter. Having problems putting
                    > my hands on one. I have letters for just about
                    > everything but timely filing.
                    >
                    > Joktan Edison <ejoktan@...> wrote:
                    > Could anyone help me on BCBS FL Fee Schedule. I
                    > would
                    > appreciate your help!!!!
                    >
                    >
                    __________________________________________________________
                    > Never miss a thing. Make Yahoo your home page.
                    > http://www.yahoo.com/r/hs
                    >
                    >
                    >
                    >
                    >
                    > [Non-text portions of this message have been
                    > removed]
                    >
                    >






                    ____________________________________________________________________________________
                    Looking for last minute shopping deals?
                    Find them fast with Yahoo! Search. http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                  • Lin
                    You can’t get a full fee schedule unless your provider participates and in their packet should be a fee schedule. You can also send the attached via fax
                    Message 9 of 25 , Dec 5, 2007
                    • 0 Attachment
                      You can’t get a full fee schedule unless your provider participates and in
                      their packet should be a fee schedule. You can also send the attached via
                      fax with specific codes to determine fee schedule allowances.



                      http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestForm.pd
                      f





                      Linda Walker

                      Practice Managers Resource & Networking Community
                      <http://www.billerswebsite.com> http://www.billerswebsite.com
                      A division of K&L Media, LLC
                      <http://www.klmediallc.com> http://www.klmediallc.com

                      Website Design & Management for the Medical Services Industry





                      From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
                      On Behalf Of debbie brosnan
                      Sent: Wednesday, December 05, 2007 3:29 PM
                      To: MedicalBillers@yahoogroups.com
                      Subject: Re: [MedicalBillers] BCBS FL Fee Schedule



                      Tell us whats up??? Joktan I havent forgotten you about the appeals letter.
                      Having problems putting my hands on one. I have letters for just about
                      everything but timely filing.

                      Joktan Edison <ejoktan@... <mailto:ejoktan%40yahoo.com> > wrote: Could
                      anyone help me on BCBS FL Fee Schedule. I would
                      appreciate your help!!!!

                      __________________________________________________________
                      Never miss a thing. Make Yahoo your home page.
                      http://www.yahoo.com/r/hs

                      [Non-text portions of this message have been removed]





                      [Non-text portions of this message have been removed]
                    • Joktan Edison
                      Lin, Thanks for your reply. I did go through this form earlier this morning, however Im wanting to know whether BCBS FL insurance has any standard fee schedule
                      Message 10 of 25 , Dec 5, 2007
                      • 0 Attachment
                        Lin, Thanks for your reply. I did go through this form
                        earlier this morning, however Im wanting to know
                        whether BCBS FL insurance has any standard fee
                        schedule like Medicare has?

                        Joktan


                        --- Lin <italiandoll1967@...> wrote:

                        > You can’t get a full fee schedule unless your
                        > provider participates and in
                        > their packet should be a fee schedule. You can also
                        > send the attached via
                        > fax with specific codes to determine fee schedule
                        > allowances.
                        >
                        >
                        >
                        >
                        http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestForm.pd
                        > f
                        >
                        >
                        >
                        >
                        >
                        > Linda Walker
                        >
                        > Practice Managers Resource & Networking Community
                        > <http://www.billerswebsite.com>
                        > http://www.billerswebsite.com
                        > A division of K&L Media, LLC
                        > <http://www.klmediallc.com>
                        > http://www.klmediallc.com
                        >
                        > Website Design & Management for the Medical Services
                        > Industry
                        >
                        >
                        >
                        >
                        >
                        > From: MedicalBillers@yahoogroups.com
                        > [mailto:MedicalBillers@yahoogroups.com]
                        > On Behalf Of debbie brosnan
                        > Sent: Wednesday, December 05, 2007 3:29 PM
                        > To: MedicalBillers@yahoogroups.com
                        > Subject: Re: [MedicalBillers] BCBS FL Fee Schedule
                        >
                        >
                        >
                        > Tell us whats up??? Joktan I havent forgotten you
                        > about the appeals letter.
                        > Having problems putting my hands on one. I have
                        > letters for just about
                        > everything but timely filing.
                        >
                        > Joktan Edison <ejoktan@...
                        > <mailto:ejoktan%40yahoo.com> > wrote: Could
                        > anyone help me on BCBS FL Fee Schedule. I would
                        > appreciate your help!!!!
                        >
                        >
                        __________________________________________________________
                        > Never miss a thing. Make Yahoo your home page.
                        > http://www.yahoo.com/r/hs
                        >
                        > [Non-text portions of this message have been
                        > removed]
                        >
                        >
                        >
                        >
                        >
                        > [Non-text portions of this message have been
                        > removed]
                        >
                        >



                        ____________________________________________________________________________________
                        Never miss a thing. Make Yahoo your home page.
                        http://www.yahoo.com/r/hs
                      • djgeisel
                        Yes they all have a fe schedule! Diana ... http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF orm.pd ...
                        Message 11 of 25 , Dec 12, 2007
                        • 0 Attachment
                          Yes they all have a fe schedule! Diana
                          --- In MedicalBillers@yahoogroups.com, Joktan Edison <ejoktan@...>
                          wrote:
                          >
                          > Lin, Thanks for your reply. I did go through this form
                          > earlier this morning, however Im wanting to know
                          > whether BCBS FL insurance has any standard fee
                          > schedule like Medicare has?
                          >
                          > Joktan
                          >
                          >
                          > --- Lin <italiandoll1967@...> wrote:
                          >
                          > > You can't get a full fee schedule unless your
                          > > provider participates and in
                          > > their packet should be a fee schedule. You can also
                          > > send the attached via
                          > > fax with specific codes to determine fee schedule
                          > > allowances.
                          > >
                          > >
                          > >
                          > >
                          >
                          http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                          orm.pd
                          > > f
                          > >
                          > >
                          > >
                          > >
                          > >
                          > > Linda Walker
                          > >
                          > > Practice Managers Resource & Networking Community
                          > > <http://www.billerswebsite.com>
                          > > http://www.billerswebsite.com
                          > > A division of K&L Media, LLC
                          > > <http://www.klmediallc.com>
                          > > http://www.klmediallc.com
                          > >
                          > > Website Design & Management for the Medical Services
                          > > Industry
                          > >
                          > >
                          > >
                          > >
                          > >
                          > > From: MedicalBillers@yahoogroups.com
                          > > [mailto:MedicalBillers@yahoogroups.com]
                          > > On Behalf Of debbie brosnan
                          > > Sent: Wednesday, December 05, 2007 3:29 PM
                          > > To: MedicalBillers@yahoogroups.com
                          > > Subject: Re: [MedicalBillers] BCBS FL Fee Schedule
                          > >
                          > >
                          > >
                          > > Tell us whats up??? Joktan I havent forgotten you
                          > > about the appeals letter.
                          > > Having problems putting my hands on one. I have
                          > > letters for just about
                          > > everything but timely filing.
                          > >
                          > > Joktan Edison <ejoktan@...
                          > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                          > > anyone help me on BCBS FL Fee Schedule. I would
                          > > appreciate your help!!!!
                          > >
                          > >
                          > __________________________________________________________
                          > > Never miss a thing. Make Yahoo your home page.
                          > > http://www.yahoo.com/r/hs
                          > >
                          > > [Non-text portions of this message have been
                          > > removed]
                          > >
                          > >
                          > >
                          > >
                          > >
                          > > [Non-text portions of this message have been
                          > > removed]
                          > >
                          > >
                          >
                          >
                          >
                          >
                          ______________________________________________________________________
                          ______________
                          > Never miss a thing. Make Yahoo your home page.
                          > http://www.yahoo.com/r/hs
                          >
                        • Joktan Edison
                          Where do you I find them or else I have to request one from the BCBS FL??? Moreover, my doctor is not contracted with BCBS FL and most of the payment goes to
                          Message 12 of 25 , Dec 12, 2007
                          • 0 Attachment
                            Where do you I find them or else I have to request one
                            from the BCBS FL??? Moreover, my doctor is not
                            contracted with BCBS FL and most of the payment goes
                            to the patient? I want to bill the patient for the non
                            contracted rates rather than billing the patient the
                            entire amount. Hope you understand


                            --- djgeisel <djgeisel@...> wrote:

                            > Yes they all have a fe schedule! Diana
                            > --- In MedicalBillers@yahoogroups.com, Joktan Edison
                            > <ejoktan@...>
                            > wrote:
                            > >
                            > > Lin, Thanks for your reply. I did go through this
                            > form
                            > > earlier this morning, however Im wanting to know
                            > > whether BCBS FL insurance has any standard fee
                            > > schedule like Medicare has?
                            > >
                            > > Joktan
                            > >
                            > >
                            > > --- Lin <italiandoll1967@...> wrote:
                            > >
                            > > > You can't get a full fee schedule unless your
                            > > > provider participates and in
                            > > > their packet should be a fee schedule. You can
                            > also
                            > > > send the attached via
                            > > > fax with specific codes to determine fee
                            > schedule
                            > > > allowances.
                            > > >
                            > > >
                            > > >
                            > > >
                            > >
                            >
                            http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                            > orm.pd
                            > > > f
                            > > >
                            > > >
                            > > >
                            > > >
                            > > >
                            > > > Linda Walker
                            > > >
                            > > > Practice Managers Resource & Networking
                            > Community
                            > > > <http://www.billerswebsite.com>
                            > > > http://www.billerswebsite.com
                            > > > A division of K&L Media, LLC
                            > > > <http://www.klmediallc.com>
                            > > > http://www.klmediallc.com
                            > > >
                            > > > Website Design & Management for the Medical
                            > Services
                            > > > Industry
                            > > >
                            > > >
                            > > >
                            > > >
                            > > >
                            > > > From: MedicalBillers@yahoogroups.com
                            > > > [mailto:MedicalBillers@yahoogroups.com]
                            > > > On Behalf Of debbie brosnan
                            > > > Sent: Wednesday, December 05, 2007 3:29 PM
                            > > > To: MedicalBillers@yahoogroups.com
                            > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                            > Schedule
                            > > >
                            > > >
                            > > >
                            > > > Tell us whats up??? Joktan I havent forgotten
                            > you
                            > > > about the appeals letter.
                            > > > Having problems putting my hands on one. I have
                            > > > letters for just about
                            > > > everything but timely filing.
                            > > >
                            > > > Joktan Edison <ejoktan@...
                            > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                            > > > anyone help me on BCBS FL Fee Schedule. I would
                            > > > appreciate your help!!!!
                            > > >
                            > > >
                            > >
                            >
                            __________________________________________________________
                            > > > Never miss a thing. Make Yahoo your home page.
                            > > > http://www.yahoo.com/r/hs
                            > > >
                            > > > [Non-text portions of this message have been
                            > > > removed]
                            > > >
                            > > >
                            > > >
                            > > >
                            > > >
                            > > > [Non-text portions of this message have been
                            > > > removed]
                            > > >
                            > > >
                            > >
                            > >
                            > >
                            > >
                            >
                            ______________________________________________________________________
                            > ______________
                            > > Never miss a thing. Make Yahoo your home page.
                            > > http://www.yahoo.com/r/hs
                            > >
                            >
                            >
                            >






                            ____________________________________________________________________________________
                            Looking for last minute shopping deals?
                            Find them fast with Yahoo! Search. http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                          • Lin
                            BCBS does not honor assignment of benefits for non-par providers. BCBS patients that see a non-par doctor should pay at the time of service. They also will not
                            Message 13 of 25 , Dec 13, 2007
                            • 0 Attachment
                              BCBS does not honor assignment of benefits for non-par providers. BCBS
                              patients that see a non-par doctor should pay at the time of service. They
                              also will not release a fee schedule to the provider if he is not
                              participating.

                              Many states have tried to take BCBS To court on this very issue (not
                              honoring assignment) however it is up to the carrier to decide if they want
                              to honor assignment of benefits, therefore BCBS has not lost that battle in
                              court.

                              If you are giving the patient a "discount" of the non-allowed amount on a
                              routine basis this could be considered fraud. The patient should be paying
                              up to the providers full fee since he /she is not participating with BCBS
                              and it's best to have the patient pay at the time of service since the money
                              will go directly to them.





                              Linda Walker

                              Practice Managers Resource & Networking Community
                              <http://www.billerswebsite.com> http://www.billerswebsite.com
                              A division of K&L Media, LLC
                              <http://www.klmediallc.com> http://www.klmediallc.com

                              Website Design & Management for the Medical Services Industry





                              From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
                              On Behalf Of Joktan Edison
                              Sent: Thursday, December 13, 2007 2:11 AM
                              To: MedicalBillers@yahoogroups.com
                              Subject: Re: [MedicalBillers] Re: BCBS FL Fee Schedule



                              Where do you I find them or else I have to request one
                              from the BCBS FL??? Moreover, my doctor is not
                              contracted with BCBS FL and most of the payment goes
                              to the patient? I want to bill the patient for the non
                              contracted rates rather than billing the patient the
                              entire amount. Hope you understand

                              --- djgeisel <djgeisel@... <mailto:djgeisel%40charter.net> > wrote:

                              > Yes they all have a fe schedule! Diana
                              > --- In MedicalBillers@yahoogroups.com
                              <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                              > <ejoktan@...>
                              > wrote:
                              > >
                              > > Lin, Thanks for your reply. I did go through this
                              > form
                              > > earlier this morning, however Im wanting to know
                              > > whether BCBS FL insurance has any standard fee
                              > > schedule like Medicare has?
                              > >
                              > > Joktan
                              > >
                              > >
                              > > --- Lin <italiandoll1967@...> wrote:
                              > >
                              > > > You can't get a full fee schedule unless your
                              > > > provider participates and in
                              > > > their packet should be a fee schedule. You can
                              > also
                              > > > send the attached via
                              > > > fax with specific codes to determine fee
                              > schedule
                              > > > allowances.
                              > > >
                              > > >
                              > > >
                              > > >
                              > >
                              >
                              http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                              > orm.pd
                              > > > f
                              > > >
                              > > >
                              > > >
                              > > >
                              > > >
                              > > > Linda Walker
                              > > >
                              > > > Practice Managers Resource & Networking
                              > Community
                              > > > <http://www.billerswebsite.com>
                              > > > http://www.billerswebsite.com
                              > > > A division of K&L Media, LLC
                              > > > <http://www.klmediallc.com>
                              > > > http://www.klmediallc.com
                              > > >
                              > > > Website Design & Management for the Medical
                              > Services
                              > > > Industry
                              > > >
                              > > >
                              > > >
                              > > >
                              > > >
                              > > > From: MedicalBillers@yahoogroups.com
                              <mailto:MedicalBillers%40yahoogroups.com>
                              > > > [mailto:MedicalBillers@yahoogroups.com
                              <mailto:MedicalBillers%40yahoogroups.com> ]
                              > > > On Behalf Of debbie brosnan
                              > > > Sent: Wednesday, December 05, 2007 3:29 PM
                              > > > To: MedicalBillers@yahoogroups.com
                              <mailto:MedicalBillers%40yahoogroups.com>
                              > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                              > Schedule
                              > > >
                              > > >
                              > > >
                              > > > Tell us whats up??? Joktan I havent forgotten
                              > you
                              > > > about the appeals letter.
                              > > > Having problems putting my hands on one. I have
                              > > > letters for just about
                              > > > everything but timely filing.
                              > > >
                              > > > Joktan Edison <ejoktan@...
                              > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                              > > > anyone help me on BCBS FL Fee Schedule. I would
                              > > > appreciate your help!!!!
                              > > >
                              > > >
                              > >
                              >
                              __________________________________________________________
                              > > > Never miss a thing. Make Yahoo your home page.
                              > > > http://www.yahoo.com/r/hs
                              > > >
                              > > > [Non-text portions of this message have been
                              > > > removed]
                              > > >
                              > > >
                              > > >
                              > > >
                              > > >
                              > > > [Non-text portions of this message have been
                              > > > removed]
                              > > >
                              > > >
                              > >
                              > >
                              > >
                              > >
                              >
                              __________________________________________________________
                              > ______________
                              > > Never miss a thing. Make Yahoo your home page.
                              > > http://www.yahoo.com/r/hs
                              > >
                              >
                              >
                              >

                              __________________________________________________________
                              Looking for last minute shopping deals?
                              Find them fast with Yahoo! Search.
                              http://tools.search.yahoo.com/newsearch/category.php?category=shopping





                              [Non-text portions of this message have been removed]
                            • Joktan Edison
                              I do understand and agree to this, however our doctor does not want to lose his patients, so he advised us not to bill the patient for full and also not to
                              Message 14 of 25 , Dec 13, 2007
                              • 0 Attachment
                                I do understand and agree to this, however our doctor
                                does not want to lose his patients, so he advised us
                                not to bill the patient for full and also not to
                                charge them up front. Moreover, we are on the way to
                                get this doctor contracted with all blue plans.

                                If we have the contracted fee schedule then we could
                                calculate the out of network benefits and bill only
                                what the insurance pays the patient or else could
                                charge the same upfront rather than taking full fee.
                                Rightnow we dont have any clue what percentage BCBS FL
                                pays, it is 70% or 60%???????


                                --- Lin <italiandoll1967@...> wrote:

                                > BCBS does not honor assignment of benefits for
                                > non-par providers. BCBS
                                > patients that see a non-par doctor should pay at the
                                > time of service. They
                                > also will not release a fee schedule to the provider
                                > if he is not
                                > participating.
                                >
                                > Many states have tried to take BCBS To court on this
                                > very issue (not
                                > honoring assignment) however it is up to the carrier
                                > to decide if they want
                                > to honor assignment of benefits, therefore BCBS has
                                > not lost that battle in
                                > court.
                                >
                                > If you are giving the patient a "discount" of the
                                > non-allowed amount on a
                                > routine basis this could be considered fraud. The
                                > patient should be paying
                                > up to the providers full fee since he /she is not
                                > participating with BCBS
                                > and it's best to have the patient pay at the time of
                                > service since the money
                                > will go directly to them.
                                >
                                >
                                >
                                >
                                >
                                > Linda Walker
                                >
                                > Practice Managers Resource & Networking Community
                                > <http://www.billerswebsite.com>
                                > http://www.billerswebsite.com
                                > A division of K&L Media, LLC
                                > <http://www.klmediallc.com>
                                > http://www.klmediallc.com
                                >
                                > Website Design & Management for the Medical Services
                                > Industry
                                >
                                >
                                >
                                >
                                >
                                > From: MedicalBillers@yahoogroups.com
                                > [mailto:MedicalBillers@yahoogroups.com]
                                > On Behalf Of Joktan Edison
                                > Sent: Thursday, December 13, 2007 2:11 AM
                                > To: MedicalBillers@yahoogroups.com
                                > Subject: Re: [MedicalBillers] Re: BCBS FL Fee
                                > Schedule
                                >
                                >
                                >
                                > Where do you I find them or else I have to request
                                > one
                                > from the BCBS FL??? Moreover, my doctor is not
                                > contracted with BCBS FL and most of the payment goes
                                > to the patient? I want to bill the patient for the
                                > non
                                > contracted rates rather than billing the patient the
                                > entire amount. Hope you understand
                                >
                                > --- djgeisel <djgeisel@...
                                > <mailto:djgeisel%40charter.net> > wrote:
                                >
                                > > Yes they all have a fe schedule! Diana
                                > > --- In MedicalBillers@yahoogroups.com
                                > <mailto:MedicalBillers%40yahoogroups.com> , Joktan
                                > Edison
                                > > <ejoktan@...>
                                > > wrote:
                                > > >
                                > > > Lin, Thanks for your reply. I did go through
                                > this
                                > > form
                                > > > earlier this morning, however Im wanting to know
                                > > > whether BCBS FL insurance has any standard fee
                                > > > schedule like Medicare has?
                                > > >
                                > > > Joktan
                                > > >
                                > > >
                                > > > --- Lin <italiandoll1967@...> wrote:
                                > > >
                                > > > > You can't get a full fee schedule unless your
                                > > > > provider participates and in
                                > > > > their packet should be a fee schedule. You can
                                > > also
                                > > > > send the attached via
                                > > > > fax with specific codes to determine fee
                                > > schedule
                                > > > > allowances.
                                > > > >
                                > > > >
                                > > > >
                                > > > >
                                > > >
                                > >
                                >
                                http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                > > orm.pd
                                > > > > f
                                > > > >
                                > > > >
                                > > > >
                                > > > >
                                > > > >
                                > > > > Linda Walker
                                > > > >
                                > > > > Practice Managers Resource & Networking
                                > > Community
                                > > > > <http://www.billerswebsite.com>
                                > > > > http://www.billerswebsite.com
                                > > > > A division of K&L Media, LLC
                                > > > > <http://www.klmediallc.com>
                                > > > > http://www.klmediallc.com
                                > > > >
                                > > > > Website Design & Management for the Medical
                                > > Services
                                > > > > Industry
                                > > > >
                                > > > >
                                > > > >
                                > > > >
                                > > > >
                                > > > > From: MedicalBillers@yahoogroups.com
                                > <mailto:MedicalBillers%40yahoogroups.com>
                                > > > > [mailto:MedicalBillers@yahoogroups.com
                                > <mailto:MedicalBillers%40yahoogroups.com> ]
                                > > > > On Behalf Of debbie brosnan
                                > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                > > > > To: MedicalBillers@yahoogroups.com
                                > <mailto:MedicalBillers%40yahoogroups.com>
                                > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                > > Schedule
                                > > > >
                                > > > >
                                > > > >
                                > > > > Tell us whats up??? Joktan I havent forgotten
                                > > you
                                > > > > about the appeals letter.
                                > > > > Having problems putting my hands on one. I
                                > have
                                > > > > letters for just about
                                > > > > everything but timely filing.
                                > > > >
                                > > > > Joktan Edison <ejoktan@...
                                > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                > > > > anyone help me on BCBS FL Fee Schedule. I
                                > would
                                > > > > appreciate your help!!!!
                                > > > >
                                > > > >
                                > > >
                                > >
                                >
                                __________________________________________________________
                                > > > > Never miss a thing. Make Yahoo your home page.
                                >
                                > > > > http://www.yahoo.com/r/hs
                                > > > >
                                > > > > [Non-text portions of this message have been
                                > > > > removed]
                                > > > >
                                > > > >
                                > > > >
                                > > > >
                                > > > >
                                > > > > [Non-text portions of this message have been
                                > > > > removed]
                                > > > >
                                > > > >
                                > > >
                                > > >
                                > > >
                                > > >
                                > >
                                >
                                __________________________________________________________
                                > > ______________
                                > > > Never miss a thing. Make Yahoo your home page.
                                > > > http://www.yahoo.com/r/hs
                                > > >
                                > >
                                > >
                                > >
                                >
                                >
                                __________________________________________________________
                                > Looking for last minute shopping deals?
                                > Find them fast with Yahoo! Search.
                                >
                                http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                                >
                                >
                                >
                                >
                                >
                                > [Non-text portions of this message have been
                                > removed]
                                >
                                >






                                ____________________________________________________________________________________
                                Looking for last minute shopping deals?
                                Find them fast with Yahoo! Search. http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                              • Lin
                                There are several plans for BCBS and they also pay based on tiered fee schedule and also your non par, so you really are not going to get a set fee schedule. I
                                Message 15 of 25 , Dec 13, 2007
                                • 0 Attachment
                                  There are several plans for BCBS and they also pay based on tiered fee
                                  schedule and also your non par, so you really are not going to get a set fee
                                  schedule. I would suggest beginning the application process for
                                  credentialing him with BCBS and this way you will receive the appropriate
                                  fee schedule.

                                  Again , though Routinely TWIPPING (Taking What Insurance Pays as payment in
                                  full) is fraud, so I would tread carefully. I understand the doctor wants to
                                  keep the patient happy but breaking the law is not going to make him happy
                                  and as the biller your not going to be happy as you are just as responsible
                                  for "knowing".

                                  In addition, the patient is also in breach of contract as the policy holder,
                                  their plan outlines the payment and out of pocket terms for non
                                  participating providers.





                                  Linda Walker

                                  Practice Managers Resource & Networking Community
                                  <http://www.billerswebsite.com> http://www.billerswebsite.com
                                  A division of K&L Media, LLC
                                  <http://www.klmediallc.com> http://www.klmediallc.com

                                  Website Design & Management for the Medical Services Industry





                                  From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
                                  On Behalf Of Joktan Edison
                                  Sent: Thursday, December 13, 2007 8:05 AM
                                  To: MedicalBillers@yahoogroups.com
                                  Subject: RE: [MedicalBillers] Re: BCBS FL Fee Schedule



                                  I do understand and agree to this, however our doctor
                                  does not want to lose his patients, so he advised us
                                  not to bill the patient for full and also not to
                                  charge them up front. Moreover, we are on the way to
                                  get this doctor contracted with all blue plans.

                                  If we have the contracted fee schedule then we could
                                  calculate the out of network benefits and bill only
                                  what the insurance pays the patient or else could
                                  charge the same upfront rather than taking full fee.
                                  Rightnow we dont have any clue what percentage BCBS FL
                                  pays, it is 70% or 60%???????

                                  --- Lin <italiandoll1967@... <mailto:italiandoll1967%40yahoo.com> >
                                  wrote:

                                  > BCBS does not honor assignment of benefits for
                                  > non-par providers. BCBS
                                  > patients that see a non-par doctor should pay at the
                                  > time of service. They
                                  > also will not release a fee schedule to the provider
                                  > if he is not
                                  > participating.
                                  >
                                  > Many states have tried to take BCBS To court on this
                                  > very issue (not
                                  > honoring assignment) however it is up to the carrier
                                  > to decide if they want
                                  > to honor assignment of benefits, therefore BCBS has
                                  > not lost that battle in
                                  > court.
                                  >
                                  > If you are giving the patient a "discount" of the
                                  > non-allowed amount on a
                                  > routine basis this could be considered fraud. The
                                  > patient should be paying
                                  > up to the providers full fee since he /she is not
                                  > participating with BCBS
                                  > and it's best to have the patient pay at the time of
                                  > service since the money
                                  > will go directly to them.
                                  >
                                  >
                                  >
                                  >
                                  >
                                  > Linda Walker
                                  >
                                  > Practice Managers Resource & Networking Community
                                  > <http://www.billerswebsite.com>
                                  > http://www.billerswebsite.com
                                  > A division of K&L Media, LLC
                                  > <http://www.klmediallc.com>
                                  > http://www.klmediallc.com
                                  >
                                  > Website Design & Management for the Medical Services
                                  > Industry
                                  >
                                  >
                                  >
                                  >
                                  >
                                  > From: MedicalBillers@yahoogroups.com
                                  <mailto:MedicalBillers%40yahoogroups.com>
                                  > [mailto:MedicalBillers@yahoogroups.com
                                  <mailto:MedicalBillers%40yahoogroups.com> ]
                                  > On Behalf Of Joktan Edison
                                  > Sent: Thursday, December 13, 2007 2:11 AM
                                  > To: MedicalBillers@yahoogroups.com
                                  <mailto:MedicalBillers%40yahoogroups.com>
                                  > Subject: Re: [MedicalBillers] Re: BCBS FL Fee
                                  > Schedule
                                  >
                                  >
                                  >
                                  > Where do you I find them or else I have to request
                                  > one
                                  > from the BCBS FL??? Moreover, my doctor is not
                                  > contracted with BCBS FL and most of the payment goes
                                  > to the patient? I want to bill the patient for the
                                  > non
                                  > contracted rates rather than billing the patient the
                                  > entire amount. Hope you understand
                                  >
                                  > --- djgeisel <djgeisel@... <mailto:djgeisel%40charter.net>
                                  > <mailto:djgeisel%40charter.net> > wrote:
                                  >
                                  > > Yes they all have a fe schedule! Diana
                                  > > --- In MedicalBillers@yahoogroups.com
                                  <mailto:MedicalBillers%40yahoogroups.com>
                                  > <mailto:MedicalBillers%40yahoogroups.com> , Joktan
                                  > Edison
                                  > > <ejoktan@...>
                                  > > wrote:
                                  > > >
                                  > > > Lin, Thanks for your reply. I did go through
                                  > this
                                  > > form
                                  > > > earlier this morning, however Im wanting to know
                                  > > > whether BCBS FL insurance has any standard fee
                                  > > > schedule like Medicare has?
                                  > > >
                                  > > > Joktan
                                  > > >
                                  > > >
                                  > > > --- Lin <italiandoll1967@...> wrote:
                                  > > >
                                  > > > > You can't get a full fee schedule unless your
                                  > > > > provider participates and in
                                  > > > > their packet should be a fee schedule. You can
                                  > > also
                                  > > > > send the attached via
                                  > > > > fax with specific codes to determine fee
                                  > > schedule
                                  > > > > allowances.
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > >
                                  > >
                                  >
                                  http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                  > > orm.pd
                                  > > > > f
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > > Linda Walker
                                  > > > >
                                  > > > > Practice Managers Resource & Networking
                                  > > Community
                                  > > > > <http://www.billerswebsite.com>
                                  > > > > http://www.billerswebsite.com
                                  > > > > A division of K&L Media, LLC
                                  > > > > <http://www.klmediallc.com>
                                  > > > > http://www.klmediallc.com
                                  > > > >
                                  > > > > Website Design & Management for the Medical
                                  > > Services
                                  > > > > Industry
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > > From: MedicalBillers@yahoogroups.com
                                  <mailto:MedicalBillers%40yahoogroups.com>
                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                  > > > > [mailto:MedicalBillers@yahoogroups.com
                                  <mailto:MedicalBillers%40yahoogroups.com>
                                  > <mailto:MedicalBillers%40yahoogroups.com> ]
                                  > > > > On Behalf Of debbie brosnan
                                  > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                  > > > > To: MedicalBillers@yahoogroups.com
                                  <mailto:MedicalBillers%40yahoogroups.com>
                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                  > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                  > > Schedule
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > > Tell us whats up??? Joktan I havent forgotten
                                  > > you
                                  > > > > about the appeals letter.
                                  > > > > Having problems putting my hands on one. I
                                  > have
                                  > > > > letters for just about
                                  > > > > everything but timely filing.
                                  > > > >
                                  > > > > Joktan Edison <ejoktan@...
                                  > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                  > > > > anyone help me on BCBS FL Fee Schedule. I
                                  > would
                                  > > > > appreciate your help!!!!
                                  > > > >
                                  > > > >
                                  > > >
                                  > >
                                  >
                                  __________________________________________________________
                                  > > > > Never miss a thing. Make Yahoo your home page.
                                  >
                                  > > > > http://www.yahoo.com/r/hs
                                  > > > >
                                  > > > > [Non-text portions of this message have been
                                  > > > > removed]
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > >
                                  > > > > [Non-text portions of this message have been
                                  > > > > removed]
                                  > > > >
                                  > > > >
                                  > > >
                                  > > >
                                  > > >
                                  > > >
                                  > >
                                  >
                                  __________________________________________________________
                                  > > ______________
                                  > > > Never miss a thing. Make Yahoo your home page.
                                  > > > http://www.yahoo.com/r/hs
                                  > > >
                                  > >
                                  > >
                                  > >
                                  >
                                  >
                                  __________________________________________________________
                                  > Looking for last minute shopping deals?
                                  > Find them fast with Yahoo! Search.
                                  >
                                  http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                                  >
                                  >
                                  >
                                  >
                                  >
                                  > [Non-text portions of this message have been
                                  > removed]
                                  >
                                  >

                                  __________________________________________________________
                                  Looking for last minute shopping deals?
                                  Find them fast with Yahoo! Search.
                                  http://tools.search.yahoo.com/newsearch/category.php?category=shopping





                                  [Non-text portions of this message have been removed]
                                • djgeisel
                                  You could wait for the EOB or 835 and post from that only the amount paid to the patient, but if you are not par maybe you don t even get an EOB? Many
                                  Message 16 of 25 , Dec 13, 2007
                                  • 0 Attachment
                                    You could wait for the EOB or 835 and post from that only the amount
                                    paid to the patient, but if you are not par maybe you don't even get
                                    an EOB? Many carriers post thier fee schedule on the web site and
                                    the out of network coverage is based on the fee schedule at a lesser
                                    amount than in network...I think. We are in network (not with Fla)
                                    but I used to work for a doc who was out of network and I think that
                                    is how it worked. If you know of a provider who is in network maybe
                                    you can get the fee schedule from them? Diana

                                    --- In MedicalBillers@yahoogroups.com, Joktan Edison <ejoktan@...>
                                    wrote:
                                    >
                                    > Where do you I find them or else I have to request one
                                    > from the BCBS FL??? Moreover, my doctor is not
                                    > contracted with BCBS FL and most of the payment goes
                                    > to the patient? I want to bill the patient for the non
                                    > contracted rates rather than billing the patient the
                                    > entire amount. Hope you understand
                                    >
                                    >
                                    > --- djgeisel <djgeisel@...> wrote:
                                    >
                                    > > Yes they all have a fe schedule! Diana
                                    > > --- In MedicalBillers@yahoogroups.com, Joktan Edison
                                    > > <ejoktan@>
                                    > > wrote:
                                    > > >
                                    > > > Lin, Thanks for your reply. I did go through this
                                    > > form
                                    > > > earlier this morning, however Im wanting to know
                                    > > > whether BCBS FL insurance has any standard fee
                                    > > > schedule like Medicare has?
                                    > > >
                                    > > > Joktan
                                    > > >
                                    > > >
                                    > > > --- Lin <italiandoll1967@> wrote:
                                    > > >
                                    > > > > You can't get a full fee schedule unless your
                                    > > > > provider participates and in
                                    > > > > their packet should be a fee schedule. You can
                                    > > also
                                    > > > > send the attached via
                                    > > > > fax with specific codes to determine fee
                                    > > schedule
                                    > > > > allowances.
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > >
                                    > >
                                    >
                                    http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                    > > orm.pd
                                    > > > > f
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > > Linda Walker
                                    > > > >
                                    > > > > Practice Managers Resource & Networking
                                    > > Community
                                    > > > > <http://www.billerswebsite.com>
                                    > > > > http://www.billerswebsite.com
                                    > > > > A division of K&L Media, LLC
                                    > > > > <http://www.klmediallc.com>
                                    > > > > http://www.klmediallc.com
                                    > > > >
                                    > > > > Website Design & Management for the Medical
                                    > > Services
                                    > > > > Industry
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > > From: MedicalBillers@yahoogroups.com
                                    > > > > [mailto:MedicalBillers@yahoogroups.com]
                                    > > > > On Behalf Of debbie brosnan
                                    > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                    > > > > To: MedicalBillers@yahoogroups.com
                                    > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                    > > Schedule
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > > Tell us whats up??? Joktan I havent forgotten
                                    > > you
                                    > > > > about the appeals letter.
                                    > > > > Having problems putting my hands on one. I have
                                    > > > > letters for just about
                                    > > > > everything but timely filing.
                                    > > > >
                                    > > > > Joktan Edison <ejoktan@
                                    > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                    > > > > anyone help me on BCBS FL Fee Schedule. I would
                                    > > > > appreciate your help!!!!
                                    > > > >
                                    > > > >
                                    > > >
                                    > >
                                    > __________________________________________________________
                                    > > > > Never miss a thing. Make Yahoo your home page.
                                    > > > > http://www.yahoo.com/r/hs
                                    > > > >
                                    > > > > [Non-text portions of this message have been
                                    > > > > removed]
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > >
                                    > > > > [Non-text portions of this message have been
                                    > > > > removed]
                                    > > > >
                                    > > > >
                                    > > >
                                    > > >
                                    > > >
                                    > > >
                                    > >
                                    >
                                    ______________________________________________________________________
                                    > > ______________
                                    > > > Never miss a thing. Make Yahoo your home page.
                                    > > > http://www.yahoo.com/r/hs
                                    > > >
                                    > >
                                    > >
                                    > >
                                    >
                                    >
                                    >
                                    >
                                    >
                                    >
                                    >
                                    ______________________________________________________________________
                                    ______________
                                    > Looking for last minute shopping deals?
                                    > Find them fast with Yahoo! Search.
                                    http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                                    >
                                  • djgeisel
                                    Call them and use the DR tax ID or NPI, give them the patient ID, name and birthdate and ask for benefit information. Have your questins ready. I use a form
                                    Message 17 of 25 , Dec 13, 2007
                                    • 0 Attachment
                                      Call them and use the DR tax ID or NPI, give them the patient ID,
                                      name and birthdate and ask for benefit information. Have your
                                      questins ready. I use a form I made for our specialty. It will give
                                      you in and out of network benefits. It won't be the same for all BC
                                      patients. Some will be covered @ a co-ins rate or a co-pay rate and
                                      there may be no ded on one and ded on the next. That is dictated by
                                      the plan the employer signs up and negotiates for. You will only
                                      know by calling or waiting for an EOB or 835 (ERA).
                                      --- In MedicalBillers@yahoogroups.com, Joktan Edison <ejoktan@...>
                                      wrote:
                                      >
                                      > I do understand and agree to this, however our doctor
                                      > does not want to lose his patients, so he advised us
                                      > not to bill the patient for full and also not to
                                      > charge them up front. Moreover, we are on the way to
                                      > get this doctor contracted with all blue plans.
                                      >
                                      > If we have the contracted fee schedule then we could
                                      > calculate the out of network benefits and bill only
                                      > what the insurance pays the patient or else could
                                      > charge the same upfront rather than taking full fee.
                                      > Rightnow we dont have any clue what percentage BCBS FL
                                      > pays, it is 70% or 60%???????
                                      >
                                      >
                                      > --- Lin <italiandoll1967@...> wrote:
                                      >
                                      > > BCBS does not honor assignment of benefits for
                                      > > non-par providers. BCBS
                                      > > patients that see a non-par doctor should pay at the
                                      > > time of service. They
                                      > > also will not release a fee schedule to the provider
                                      > > if he is not
                                      > > participating.
                                      > >
                                      > > Many states have tried to take BCBS To court on this
                                      > > very issue (not
                                      > > honoring assignment) however it is up to the carrier
                                      > > to decide if they want
                                      > > to honor assignment of benefits, therefore BCBS has
                                      > > not lost that battle in
                                      > > court.
                                      > >
                                      > > If you are giving the patient a "discount" of the
                                      > > non-allowed amount on a
                                      > > routine basis this could be considered fraud. The
                                      > > patient should be paying
                                      > > up to the providers full fee since he /she is not
                                      > > participating with BCBS
                                      > > and it's best to have the patient pay at the time of
                                      > > service since the money
                                      > > will go directly to them.
                                      > >
                                      > >
                                      > >
                                      > >
                                      > >
                                      > > Linda Walker
                                      > >
                                      > > Practice Managers Resource & Networking Community
                                      > > <http://www.billerswebsite.com>
                                      > > http://www.billerswebsite.com
                                      > > A division of K&L Media, LLC
                                      > > <http://www.klmediallc.com>
                                      > > http://www.klmediallc.com
                                      > >
                                      > > Website Design & Management for the Medical Services
                                      > > Industry
                                      > >
                                      > >
                                      > >
                                      > >
                                      > >
                                      > > From: MedicalBillers@yahoogroups.com
                                      > > [mailto:MedicalBillers@yahoogroups.com]
                                      > > On Behalf Of Joktan Edison
                                      > > Sent: Thursday, December 13, 2007 2:11 AM
                                      > > To: MedicalBillers@yahoogroups.com
                                      > > Subject: Re: [MedicalBillers] Re: BCBS FL Fee
                                      > > Schedule
                                      > >
                                      > >
                                      > >
                                      > > Where do you I find them or else I have to request
                                      > > one
                                      > > from the BCBS FL??? Moreover, my doctor is not
                                      > > contracted with BCBS FL and most of the payment goes
                                      > > to the patient? I want to bill the patient for the
                                      > > non
                                      > > contracted rates rather than billing the patient the
                                      > > entire amount. Hope you understand
                                      > >
                                      > > --- djgeisel <djgeisel@...
                                      > > <mailto:djgeisel%40charter.net> > wrote:
                                      > >
                                      > > > Yes they all have a fe schedule! Diana
                                      > > > --- In MedicalBillers@yahoogroups.com
                                      > > <mailto:MedicalBillers%40yahoogroups.com> , Joktan
                                      > > Edison
                                      > > > <ejoktan@>
                                      > > > wrote:
                                      > > > >
                                      > > > > Lin, Thanks for your reply. I did go through
                                      > > this
                                      > > > form
                                      > > > > earlier this morning, however Im wanting to know
                                      > > > > whether BCBS FL insurance has any standard fee
                                      > > > > schedule like Medicare has?
                                      > > > >
                                      > > > > Joktan
                                      > > > >
                                      > > > >
                                      > > > > --- Lin <italiandoll1967@> wrote:
                                      > > > >
                                      > > > > > You can't get a full fee schedule unless your
                                      > > > > > provider participates and in
                                      > > > > > their packet should be a fee schedule. You can
                                      > > > also
                                      > > > > > send the attached via
                                      > > > > > fax with specific codes to determine fee
                                      > > > schedule
                                      > > > > > allowances.
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > >
                                      > > >
                                      > >
                                      >
                                      http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                      > > > orm.pd
                                      > > > > > f
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > > Linda Walker
                                      > > > > >
                                      > > > > > Practice Managers Resource & Networking
                                      > > > Community
                                      > > > > > <http://www.billerswebsite.com>
                                      > > > > > http://www.billerswebsite.com
                                      > > > > > A division of K&L Media, LLC
                                      > > > > > <http://www.klmediallc.com>
                                      > > > > > http://www.klmediallc.com
                                      > > > > >
                                      > > > > > Website Design & Management for the Medical
                                      > > > Services
                                      > > > > > Industry
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > > From: MedicalBillers@yahoogroups.com
                                      > > <mailto:MedicalBillers%40yahoogroups.com>
                                      > > > > > [mailto:MedicalBillers@yahoogroups.com
                                      > > <mailto:MedicalBillers%40yahoogroups.com> ]
                                      > > > > > On Behalf Of debbie brosnan
                                      > > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                      > > > > > To: MedicalBillers@yahoogroups.com
                                      > > <mailto:MedicalBillers%40yahoogroups.com>
                                      > > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                      > > > Schedule
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > > Tell us whats up??? Joktan I havent forgotten
                                      > > > you
                                      > > > > > about the appeals letter.
                                      > > > > > Having problems putting my hands on one. I
                                      > > have
                                      > > > > > letters for just about
                                      > > > > > everything but timely filing.
                                      > > > > >
                                      > > > > > Joktan Edison <ejoktan@
                                      > > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                      > > > > > anyone help me on BCBS FL Fee Schedule. I
                                      > > would
                                      > > > > > appreciate your help!!!!
                                      > > > > >
                                      > > > > >
                                      > > > >
                                      > > >
                                      > >
                                      > __________________________________________________________
                                      > > > > > Never miss a thing. Make Yahoo your home page.
                                      > >
                                      > > > > > http://www.yahoo.com/r/hs
                                      > > > > >
                                      > > > > > [Non-text portions of this message have been
                                      > > > > > removed]
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > >
                                      > > > > > [Non-text portions of this message have been
                                      > > > > > removed]
                                      > > > > >
                                      > > > > >
                                      > > > >
                                      > > > >
                                      > > > >
                                      > > > >
                                      > > >
                                      > >
                                      > __________________________________________________________
                                      > > > ______________
                                      > > > > Never miss a thing. Make Yahoo your home page.
                                      > > > > http://www.yahoo.com/r/hs
                                      > > > >
                                      > > >
                                      > > >
                                      > > >
                                      > >
                                      > >
                                      > __________________________________________________________
                                      > > Looking for last minute shopping deals?
                                      > > Find them fast with Yahoo! Search.
                                      > >
                                      > http://tools.search.yahoo.com/newsearch/category.php?
                                      category=shopping
                                      > >
                                      > >
                                      > >
                                      > >
                                      > >
                                      > > [Non-text portions of this message have been
                                      > > removed]
                                      > >
                                      > >
                                      >
                                      >
                                      >
                                      >
                                      >
                                      >
                                      >
                                      ______________________________________________________________________
                                      ______________
                                      > Looking for last minute shopping deals?
                                      > Find them fast with Yahoo! Search.
                                      http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                                      >
                                    • Lin
                                      Non Par will go by R&C/U&C and then the out of pocket is the coinsurance of the plan. For example if the doctors charge is $50 and he is non par, the patient
                                      Message 18 of 25 , Dec 13, 2007
                                      • 0 Attachment
                                        Non Par will go by R&C/U&C and then the out of pocket is the coinsurance of
                                        the plan. For example if the doctors charge is $50 and he is non par, the
                                        patient might have 20% coinsurance and the R&C (not published nor given out
                                        by any carrier) may be $48. In which case the patient is still responsible
                                        for $25

                                        There is no fee schedule for NON par providers, it goes by the plan benefit.

                                        If the provider was participating he would be entitled to the fee schedule.





                                        Linda Walker

                                        Practice Managers Resource & Networking Community
                                        <http://www.billerswebsite.com> http://www.billerswebsite.com
                                        A division of K&L Media, LLC
                                        <http://www.klmediallc.com> http://www.klmediallc.com

                                        Website Design & Management for the Medical Services Industry





                                        From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
                                        On Behalf Of djgeisel
                                        Sent: Thursday, December 13, 2007 4:01 PM
                                        To: MedicalBillers@yahoogroups.com
                                        Subject: [MedicalBillers] Re: BCBS FL Fee Schedule



                                        You could wait for the EOB or 835 and post from that only the amount
                                        paid to the patient, but if you are not par maybe you don't even get
                                        an EOB? Many carriers post thier fee schedule on the web site and
                                        the out of network coverage is based on the fee schedule at a lesser
                                        amount than in network...I think. We are in network (not with Fla)
                                        but I used to work for a doc who was out of network and I think that
                                        is how it worked. If you know of a provider who is in network maybe
                                        you can get the fee schedule from them? Diana

                                        --- In MedicalBillers@yahoogroups.com
                                        <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison <ejoktan@...>
                                        wrote:
                                        >
                                        > Where do you I find them or else I have to request one
                                        > from the BCBS FL??? Moreover, my doctor is not
                                        > contracted with BCBS FL and most of the payment goes
                                        > to the patient? I want to bill the patient for the non
                                        > contracted rates rather than billing the patient the
                                        > entire amount. Hope you understand
                                        >
                                        >
                                        > --- djgeisel <djgeisel@...> wrote:
                                        >
                                        > > Yes they all have a fe schedule! Diana
                                        > > --- In MedicalBillers@yahoogroups.com
                                        <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                        > > <ejoktan@>
                                        > > wrote:
                                        > > >
                                        > > > Lin, Thanks for your reply. I did go through this
                                        > > form
                                        > > > earlier this morning, however Im wanting to know
                                        > > > whether BCBS FL insurance has any standard fee
                                        > > > schedule like Medicare has?
                                        > > >
                                        > > > Joktan
                                        > > >
                                        > > >
                                        > > > --- Lin <italiandoll1967@> wrote:
                                        > > >
                                        > > > > You can't get a full fee schedule unless your
                                        > > > > provider participates and in
                                        > > > > their packet should be a fee schedule. You can
                                        > > also
                                        > > > > send the attached via
                                        > > > > fax with specific codes to determine fee
                                        > > schedule
                                        > > > > allowances.
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > >
                                        > >
                                        >
                                        http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                        > > orm.pd
                                        > > > > f
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > > Linda Walker
                                        > > > >
                                        > > > > Practice Managers Resource & Networking
                                        > > Community
                                        > > > > <http://www.billerswebsite.com>
                                        > > > > http://www.billerswebsite.com
                                        > > > > A division of K&L Media, LLC
                                        > > > > <http://www.klmediallc.com>
                                        > > > > http://www.klmediallc.com
                                        > > > >
                                        > > > > Website Design & Management for the Medical
                                        > > Services
                                        > > > > Industry
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > > From: MedicalBillers@yahoogroups.com
                                        <mailto:MedicalBillers%40yahoogroups.com>
                                        > > > > [mailto:MedicalBillers@yahoogroups.com
                                        <mailto:MedicalBillers%40yahoogroups.com> ]
                                        > > > > On Behalf Of debbie brosnan
                                        > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                        > > > > To: MedicalBillers@yahoogroups.com
                                        <mailto:MedicalBillers%40yahoogroups.com>
                                        > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                        > > Schedule
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > > Tell us whats up??? Joktan I havent forgotten
                                        > > you
                                        > > > > about the appeals letter.
                                        > > > > Having problems putting my hands on one. I have
                                        > > > > letters for just about
                                        > > > > everything but timely filing.
                                        > > > >
                                        > > > > Joktan Edison <ejoktan@
                                        > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                        > > > > anyone help me on BCBS FL Fee Schedule. I would
                                        > > > > appreciate your help!!!!
                                        > > > >
                                        > > > >
                                        > > >
                                        > >
                                        > __________________________________________________________
                                        > > > > Never miss a thing. Make Yahoo your home page.
                                        > > > > http://www.yahoo.com/r/hs
                                        > > > >
                                        > > > > [Non-text portions of this message have been
                                        > > > > removed]
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > >
                                        > > > > [Non-text portions of this message have been
                                        > > > > removed]
                                        > > > >
                                        > > > >
                                        > > >
                                        > > >
                                        > > >
                                        > > >
                                        > >
                                        >
                                        __________________________________________________________
                                        > > ______________
                                        > > > Never miss a thing. Make Yahoo your home page.
                                        > > > http://www.yahoo.com/r/hs
                                        > > >
                                        > >
                                        > >
                                        > >
                                        >
                                        >
                                        >
                                        >
                                        >
                                        >
                                        >
                                        __________________________________________________________
                                        ______________
                                        > Looking for last minute shopping deals?
                                        > Find them fast with Yahoo! Search.
                                        http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                                        >





                                        [Non-text portions of this message have been removed]
                                      • djgeisel
                                        So I think he wants to know how to find out what R&C/U&C is for that state and provider. Do you know that or how to get that information? Diana ...
                                        Message 19 of 25 , Dec 13, 2007
                                        • 0 Attachment
                                          So I think he wants to know how to find out what R&C/U&C is for that
                                          state and provider. Do you know that or how to get that
                                          information? Diana
                                          --- In MedicalBillers@yahoogroups.com, "Lin" <italiandoll1967@...>
                                          wrote:
                                          >
                                          > Non Par will go by R&C/U&C and then the out of pocket is the
                                          coinsurance of
                                          > the plan. For example if the doctors charge is $50 and he is non
                                          par, the
                                          > patient might have 20% coinsurance and the R&C (not published nor
                                          given out
                                          > by any carrier) may be $48. In which case the patient is still
                                          responsible
                                          > for $25
                                          >
                                          > There is no fee schedule for NON par providers, it goes by the plan
                                          benefit.
                                          >
                                          > If the provider was participating he would be entitled to the fee
                                          schedule.
                                          >
                                          >
                                          >
                                          >
                                          >
                                          > Linda Walker
                                          >
                                          > Practice Managers Resource & Networking Community
                                          > <http://www.billerswebsite.com> http://www.billerswebsite.com
                                          > A division of K&L Media, LLC
                                          > <http://www.klmediallc.com> http://www.klmediallc.com
                                          >
                                          > Website Design & Management for the Medical Services Industry
                                          >
                                          >
                                          >
                                          >
                                          >
                                          > From: MedicalBillers@yahoogroups.com
                                          [mailto:MedicalBillers@yahoogroups.com]
                                          > On Behalf Of djgeisel
                                          > Sent: Thursday, December 13, 2007 4:01 PM
                                          > To: MedicalBillers@yahoogroups.com
                                          > Subject: [MedicalBillers] Re: BCBS FL Fee Schedule
                                          >
                                          >
                                          >
                                          > You could wait for the EOB or 835 and post from that only the
                                          amount
                                          > paid to the patient, but if you are not par maybe you don't even
                                          get
                                          > an EOB? Many carriers post thier fee schedule on the web site and
                                          > the out of network coverage is based on the fee schedule at a
                                          lesser
                                          > amount than in network...I think. We are in network (not with Fla)
                                          > but I used to work for a doc who was out of network and I think
                                          that
                                          > is how it worked. If you know of a provider who is in network maybe
                                          > you can get the fee schedule from them? Diana
                                          >
                                          > --- In MedicalBillers@yahoogroups.com
                                          > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                          <ejoktan@>
                                          > wrote:
                                          > >
                                          > > Where do you I find them or else I have to request one
                                          > > from the BCBS FL??? Moreover, my doctor is not
                                          > > contracted with BCBS FL and most of the payment goes
                                          > > to the patient? I want to bill the patient for the non
                                          > > contracted rates rather than billing the patient the
                                          > > entire amount. Hope you understand
                                          > >
                                          > >
                                          > > --- djgeisel <djgeisel@> wrote:
                                          > >
                                          > > > Yes they all have a fe schedule! Diana
                                          > > > --- In MedicalBillers@yahoogroups.com
                                          > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                          > > > <ejoktan@>
                                          > > > wrote:
                                          > > > >
                                          > > > > Lin, Thanks for your reply. I did go through this
                                          > > > form
                                          > > > > earlier this morning, however Im wanting to know
                                          > > > > whether BCBS FL insurance has any standard fee
                                          > > > > schedule like Medicare has?
                                          > > > >
                                          > > > > Joktan
                                          > > > >
                                          > > > >
                                          > > > > --- Lin <italiandoll1967@> wrote:
                                          > > > >
                                          > > > > > You can't get a full fee schedule unless your
                                          > > > > > provider participates and in
                                          > > > > > their packet should be a fee schedule. You can
                                          > > > also
                                          > > > > > send the attached via
                                          > > > > > fax with specific codes to determine fee
                                          > > > schedule
                                          > > > > > allowances.
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > >
                                          > > >
                                          > >
                                          >
                                          http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                          > > > orm.pd
                                          > > > > > f
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > > Linda Walker
                                          > > > > >
                                          > > > > > Practice Managers Resource & Networking
                                          > > > Community
                                          > > > > > <http://www.billerswebsite.com>
                                          > > > > > http://www.billerswebsite.com
                                          > > > > > A division of K&L Media, LLC
                                          > > > > > <http://www.klmediallc.com>
                                          > > > > > http://www.klmediallc.com
                                          > > > > >
                                          > > > > > Website Design & Management for the Medical
                                          > > > Services
                                          > > > > > Industry
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > > From: MedicalBillers@yahoogroups.com
                                          > <mailto:MedicalBillers%40yahoogroups.com>
                                          > > > > > [mailto:MedicalBillers@yahoogroups.com
                                          > <mailto:MedicalBillers%40yahoogroups.com> ]
                                          > > > > > On Behalf Of debbie brosnan
                                          > > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                          > > > > > To: MedicalBillers@yahoogroups.com
                                          > <mailto:MedicalBillers%40yahoogroups.com>
                                          > > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                          > > > Schedule
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > > Tell us whats up??? Joktan I havent forgotten
                                          > > > you
                                          > > > > > about the appeals letter.
                                          > > > > > Having problems putting my hands on one. I have
                                          > > > > > letters for just about
                                          > > > > > everything but timely filing.
                                          > > > > >
                                          > > > > > Joktan Edison <ejoktan@
                                          > > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                          > > > > > anyone help me on BCBS FL Fee Schedule. I would
                                          > > > > > appreciate your help!!!!
                                          > > > > >
                                          > > > > >
                                          > > > >
                                          > > >
                                          > > __________________________________________________________
                                          > > > > > Never miss a thing. Make Yahoo your home page.
                                          > > > > > http://www.yahoo.com/r/hs
                                          > > > > >
                                          > > > > > [Non-text portions of this message have been
                                          > > > > > removed]
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > >
                                          > > > > > [Non-text portions of this message have been
                                          > > > > > removed]
                                          > > > > >
                                          > > > > >
                                          > > > >
                                          > > > >
                                          > > > >
                                          > > > >
                                          > > >
                                          > >
                                          > __________________________________________________________
                                          > > > ______________
                                          > > > > Never miss a thing. Make Yahoo your home page.
                                          > > > > http://www.yahoo.com/r/hs
                                          > > > >
                                          > > >
                                          > > >
                                          > > >
                                          > >
                                          > >
                                          > >
                                          > >
                                          > >
                                          > >
                                          > >
                                          > __________________________________________________________
                                          > ______________
                                          > > Looking for last minute shopping deals?
                                          > > Find them fast with Yahoo! Search.
                                          > http://tools.search.yahoo.com/newsearch/category.php?
                                          category=shopping
                                          > >
                                          >
                                          >
                                          >
                                          >
                                          >
                                          > [Non-text portions of this message have been removed]
                                          >
                                        • Lin
                                          U&C and R&C are not given out for the very reason she wants it If you give the carrier the procedure code, your charge for the CPT code they will either
                                          Message 20 of 25 , Dec 13, 2007
                                          • 0 Attachment
                                            U&C and R&C are not given out for the very reason she wants it <g>

                                            If you give the carrier the procedure code, your charge for the CPT code
                                            they will either tell you yes it is within U&C or no it's not.

                                            They are not allowed to give out the figure unless it's via
                                            pre-determination of benefits (cpt/charge)



                                            The reason the original poster wanted to know was because the doctor only
                                            wants to collect up to the fee BCBS would allow (as though he was par) since
                                            he is not par, routinely waiving the patients coinsurance/out-of-pocket is
                                            fraudulent. That is why carriers don't release U&C so that providers are
                                            not inclined to charge only R&C.

                                            The correct way for this to be done is the provider charges the normal fee
                                            he charges for that procedure, patient pays in full at the time of visit and
                                            the patient will be reimbursed up to U&C, minus any out-of-pocket.





                                            Linda Walker

                                            Practice Managers Resource & Networking Community
                                            <http://www.billerswebsite.com> http://www.billerswebsite.com
                                            A division of K&L Media, LLC
                                            <http://www.klmediallc.com> http://www.klmediallc.com

                                            Website Design & Management for the Medical Services Industry





                                            From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
                                            On Behalf Of djgeisel
                                            Sent: Thursday, December 13, 2007 4:33 PM
                                            To: MedicalBillers@yahoogroups.com
                                            Subject: [MedicalBillers] Re: BCBS FL Fee Schedule



                                            So I think he wants to know how to find out what R&C/U&C is for that
                                            state and provider. Do you know that or how to get that
                                            information? Diana
                                            --- In MedicalBillers@yahoogroups.com
                                            <mailto:MedicalBillers%40yahoogroups.com> , "Lin" <italiandoll1967@...>
                                            wrote:
                                            >
                                            > Non Par will go by R&C/U&C and then the out of pocket is the
                                            coinsurance of
                                            > the plan. For example if the doctors charge is $50 and he is non
                                            par, the
                                            > patient might have 20% coinsurance and the R&C (not published nor
                                            given out
                                            > by any carrier) may be $48. In which case the patient is still
                                            responsible
                                            > for $25
                                            >
                                            > There is no fee schedule for NON par providers, it goes by the plan
                                            benefit.
                                            >
                                            > If the provider was participating he would be entitled to the fee
                                            schedule.
                                            >
                                            >
                                            >
                                            >
                                            >
                                            > Linda Walker
                                            >
                                            > Practice Managers Resource & Networking Community
                                            > <http://www.billerswebsite.com> http://www.billerswebsite.com
                                            > A division of K&L Media, LLC
                                            > <http://www.klmediallc.com> http://www.klmediallc.com
                                            >
                                            > Website Design & Management for the Medical Services Industry
                                            >
                                            >
                                            >
                                            >
                                            >
                                            > From: MedicalBillers@yahoogroups.com
                                            <mailto:MedicalBillers%40yahoogroups.com>
                                            [mailto:MedicalBillers@yahoogroups.com
                                            <mailto:MedicalBillers%40yahoogroups.com> ]
                                            > On Behalf Of djgeisel
                                            > Sent: Thursday, December 13, 2007 4:01 PM
                                            > To: MedicalBillers@yahoogroups.com
                                            <mailto:MedicalBillers%40yahoogroups.com>
                                            > Subject: [MedicalBillers] Re: BCBS FL Fee Schedule
                                            >
                                            >
                                            >
                                            > You could wait for the EOB or 835 and post from that only the
                                            amount
                                            > paid to the patient, but if you are not par maybe you don't even
                                            get
                                            > an EOB? Many carriers post thier fee schedule on the web site and
                                            > the out of network coverage is based on the fee schedule at a
                                            lesser
                                            > amount than in network...I think. We are in network (not with Fla)
                                            > but I used to work for a doc who was out of network and I think
                                            that
                                            > is how it worked. If you know of a provider who is in network maybe
                                            > you can get the fee schedule from them? Diana
                                            >
                                            > --- In MedicalBillers@yahoogroups.com
                                            <mailto:MedicalBillers%40yahoogroups.com>
                                            > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                            <ejoktan@>
                                            > wrote:
                                            > >
                                            > > Where do you I find them or else I have to request one
                                            > > from the BCBS FL??? Moreover, my doctor is not
                                            > > contracted with BCBS FL and most of the payment goes
                                            > > to the patient? I want to bill the patient for the non
                                            > > contracted rates rather than billing the patient the
                                            > > entire amount. Hope you understand
                                            > >
                                            > >
                                            > > --- djgeisel <djgeisel@> wrote:
                                            > >
                                            > > > Yes they all have a fe schedule! Diana
                                            > > > --- In MedicalBillers@yahoogroups.com
                                            <mailto:MedicalBillers%40yahoogroups.com>
                                            > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                            > > > <ejoktan@>
                                            > > > wrote:
                                            > > > >
                                            > > > > Lin, Thanks for your reply. I did go through this
                                            > > > form
                                            > > > > earlier this morning, however Im wanting to know
                                            > > > > whether BCBS FL insurance has any standard fee
                                            > > > > schedule like Medicare has?
                                            > > > >
                                            > > > > Joktan
                                            > > > >
                                            > > > >
                                            > > > > --- Lin <italiandoll1967@> wrote:
                                            > > > >
                                            > > > > > You can't get a full fee schedule unless your
                                            > > > > > provider participates and in
                                            > > > > > their packet should be a fee schedule. You can
                                            > > > also
                                            > > > > > send the attached via
                                            > > > > > fax with specific codes to determine fee
                                            > > > schedule
                                            > > > > > allowances.
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > >
                                            > > >
                                            > >
                                            >
                                            http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                            > > > orm.pd
                                            > > > > > f
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > > Linda Walker
                                            > > > > >
                                            > > > > > Practice Managers Resource & Networking
                                            > > > Community
                                            > > > > > <http://www.billerswebsite.com>
                                            > > > > > http://www.billerswebsite.com
                                            > > > > > A division of K&L Media, LLC
                                            > > > > > <http://www.klmediallc.com>
                                            > > > > > http://www.klmediallc.com
                                            > > > > >
                                            > > > > > Website Design & Management for the Medical
                                            > > > Services
                                            > > > > > Industry
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > > From: MedicalBillers@yahoogroups.com
                                            <mailto:MedicalBillers%40yahoogroups.com>
                                            > <mailto:MedicalBillers%40yahoogroups.com>
                                            > > > > > [mailto:MedicalBillers@yahoogroups.com
                                            <mailto:MedicalBillers%40yahoogroups.com>
                                            > <mailto:MedicalBillers%40yahoogroups.com> ]
                                            > > > > > On Behalf Of debbie brosnan
                                            > > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                            > > > > > To: MedicalBillers@yahoogroups.com
                                            <mailto:MedicalBillers%40yahoogroups.com>
                                            > <mailto:MedicalBillers%40yahoogroups.com>
                                            > > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                            > > > Schedule
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > > Tell us whats up??? Joktan I havent forgotten
                                            > > > you
                                            > > > > > about the appeals letter.
                                            > > > > > Having problems putting my hands on one. I have
                                            > > > > > letters for just about
                                            > > > > > everything but timely filing.
                                            > > > > >
                                            > > > > > Joktan Edison <ejoktan@
                                            > > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                            > > > > > anyone help me on BCBS FL Fee Schedule. I would
                                            > > > > > appreciate your help!!!!
                                            > > > > >
                                            > > > > >
                                            > > > >
                                            > > >
                                            > > __________________________________________________________
                                            > > > > > Never miss a thing. Make Yahoo your home page.
                                            > > > > > http://www.yahoo.com/r/hs
                                            > > > > >
                                            > > > > > [Non-text portions of this message have been
                                            > > > > > removed]
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > >
                                            > > > > > [Non-text portions of this message have been
                                            > > > > > removed]
                                            > > > > >
                                            > > > > >
                                            > > > >
                                            > > > >
                                            > > > >
                                            > > > >
                                            > > >
                                            > >
                                            > __________________________________________________________
                                            > > > ______________
                                            > > > > Never miss a thing. Make Yahoo your home page.
                                            > > > > http://www.yahoo.com/r/hs
                                            > > > >
                                            > > >
                                            > > >
                                            > > >
                                            > >
                                            > >
                                            > >
                                            > >
                                            > >
                                            > >
                                            > >
                                            > __________________________________________________________
                                            > ______________
                                            > > Looking for last minute shopping deals?
                                            > > Find them fast with Yahoo! Search.
                                            > http://tools.search.yahoo.com/newsearch/category.php?
                                            category=shopping
                                            > >
                                            >
                                            >
                                            >
                                            >
                                            >
                                            > [Non-text portions of this message have been removed]
                                            >





                                            [Non-text portions of this message have been removed]
                                          • djgeisel
                                            I did not read anything about waiving co-ins or ded or co-pays, and if he or she wants to accept the co-ins on the U& C fees and write off his balance that is
                                            Message 21 of 25 , Dec 13, 2007
                                            • 0 Attachment
                                              I did not read anything about waiving co-ins or ded or co-pays, and
                                              if he or she wants to accept the co-ins on the U& C fees and write
                                              off his balance that is not fraudulent. If your fee is $50 and BC
                                              says the U& C according to them is $35 and the out of network co-ins
                                              is 30%, the patient pays the total U&C fee when they pay the $35 and
                                              the doctor is not fraudulent to write off the remaining $15. He is
                                              not under contract with the carrier. Also I googled reasonable and
                                              customary and the fee schedule is used synonomously with R& C and
                                              goes partly by geographical location, it is partly what most
                                              providers charge in that area and there are other mathematical
                                              calculations that can be made to arrive at those figures but there is
                                              almost no regulation on the matter. There is a publication we get in
                                              our office called "Fee Facts" That tells us what others charge in
                                              our locality for the same procedures we do. I still say call BC and
                                              ask questions. Diana
                                              --- In MedicalBillers@yahoogroups.com, "Lin" <italiandoll1967@...>
                                              wrote:
                                              >
                                              > U&C and R&C are not given out for the very reason she wants it <g>
                                              >
                                              > If you give the carrier the procedure code, your charge for the CPT
                                              code
                                              > they will either tell you yes it is within U&C or no it's not.
                                              >
                                              > They are not allowed to give out the figure unless it's via
                                              > pre-determination of benefits (cpt/charge)
                                              >
                                              >
                                              >
                                              > The reason the original poster wanted to know was because the
                                              doctor only
                                              > wants to collect up to the fee BCBS would allow (as though he was
                                              par) since
                                              > he is not par, routinely waiving the patients coinsurance/out-of-
                                              pocket is
                                              > fraudulent. That is why carriers don't release U&C so that
                                              providers are
                                              > not inclined to charge only R&C.
                                              >
                                              > The correct way for this to be done is the provider charges the
                                              normal fee
                                              > he charges for that procedure, patient pays in full at the time of
                                              visit and
                                              > the patient will be reimbursed up to U&C, minus any out-of-pocket.
                                              >
                                              >
                                              >
                                              >
                                              >
                                              > Linda Walker
                                              >
                                              > Practice Managers Resource & Networking Community
                                              > <http://www.billerswebsite.com> http://www.billerswebsite.com
                                              > A division of K&L Media, LLC
                                              > <http://www.klmediallc.com> http://www.klmediallc.com
                                              >
                                              > Website Design & Management for the Medical Services Industry
                                              >
                                              >
                                              >
                                              >
                                              >
                                              > From: MedicalBillers@yahoogroups.com
                                              [mailto:MedicalBillers@yahoogroups.com]
                                              > On Behalf Of djgeisel
                                              > Sent: Thursday, December 13, 2007 4:33 PM
                                              > To: MedicalBillers@yahoogroups.com
                                              > Subject: [MedicalBillers] Re: BCBS FL Fee Schedule
                                              >
                                              >
                                              >
                                              > So I think he wants to know how to find out what R&C/U&C is for
                                              that
                                              > state and provider. Do you know that or how to get that
                                              > information? Diana
                                              > --- In MedicalBillers@yahoogroups.com
                                              > <mailto:MedicalBillers%40yahoogroups.com> , "Lin"
                                              <italiandoll1967@>
                                              > wrote:
                                              > >
                                              > > Non Par will go by R&C/U&C and then the out of pocket is the
                                              > coinsurance of
                                              > > the plan. For example if the doctors charge is $50 and he is non
                                              > par, the
                                              > > patient might have 20% coinsurance and the R&C (not published nor
                                              > given out
                                              > > by any carrier) may be $48. In which case the patient is still
                                              > responsible
                                              > > for $25
                                              > >
                                              > > There is no fee schedule for NON par providers, it goes by the
                                              plan
                                              > benefit.
                                              > >
                                              > > If the provider was participating he would be entitled to the fee
                                              > schedule.
                                              > >
                                              > >
                                              > >
                                              > >
                                              > >
                                              > > Linda Walker
                                              > >
                                              > > Practice Managers Resource & Networking Community
                                              > > <http://www.billerswebsite.com> http://www.billerswebsite.com
                                              > > A division of K&L Media, LLC
                                              > > <http://www.klmediallc.com> http://www.klmediallc.com
                                              > >
                                              > > Website Design & Management for the Medical Services Industry
                                              > >
                                              > >
                                              > >
                                              > >
                                              > >
                                              > > From: MedicalBillers@yahoogroups.com
                                              > <mailto:MedicalBillers%40yahoogroups.com>
                                              > [mailto:MedicalBillers@yahoogroups.com
                                              > <mailto:MedicalBillers%40yahoogroups.com> ]
                                              > > On Behalf Of djgeisel
                                              > > Sent: Thursday, December 13, 2007 4:01 PM
                                              > > To: MedicalBillers@yahoogroups.com
                                              > <mailto:MedicalBillers%40yahoogroups.com>
                                              > > Subject: [MedicalBillers] Re: BCBS FL Fee Schedule
                                              > >
                                              > >
                                              > >
                                              > > You could wait for the EOB or 835 and post from that only the
                                              > amount
                                              > > paid to the patient, but if you are not par maybe you don't even
                                              > get
                                              > > an EOB? Many carriers post thier fee schedule on the web site and
                                              > > the out of network coverage is based on the fee schedule at a
                                              > lesser
                                              > > amount than in network...I think. We are in network (not with
                                              Fla)
                                              > > but I used to work for a doc who was out of network and I think
                                              > that
                                              > > is how it worked. If you know of a provider who is in network
                                              maybe
                                              > > you can get the fee schedule from them? Diana
                                              > >
                                              > > --- In MedicalBillers@yahoogroups.com
                                              > <mailto:MedicalBillers%40yahoogroups.com>
                                              > > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                              > <ejoktan@>
                                              > > wrote:
                                              > > >
                                              > > > Where do you I find them or else I have to request one
                                              > > > from the BCBS FL??? Moreover, my doctor is not
                                              > > > contracted with BCBS FL and most of the payment goes
                                              > > > to the patient? I want to bill the patient for the non
                                              > > > contracted rates rather than billing the patient the
                                              > > > entire amount. Hope you understand
                                              > > >
                                              > > >
                                              > > > --- djgeisel <djgeisel@> wrote:
                                              > > >
                                              > > > > Yes they all have a fe schedule! Diana
                                              > > > > --- In MedicalBillers@yahoogroups.com
                                              > <mailto:MedicalBillers%40yahoogroups.com>
                                              > > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                              > > > > <ejoktan@>
                                              > > > > wrote:
                                              > > > > >
                                              > > > > > Lin, Thanks for your reply. I did go through this
                                              > > > > form
                                              > > > > > earlier this morning, however Im wanting to know
                                              > > > > > whether BCBS FL insurance has any standard fee
                                              > > > > > schedule like Medicare has?
                                              > > > > >
                                              > > > > > Joktan
                                              > > > > >
                                              > > > > >
                                              > > > > > --- Lin <italiandoll1967@> wrote:
                                              > > > > >
                                              > > > > > > You can't get a full fee schedule unless your
                                              > > > > > > provider participates and in
                                              > > > > > > their packet should be a fee schedule. You can
                                              > > > > also
                                              > > > > > > send the attached via
                                              > > > > > > fax with specific codes to determine fee
                                              > > > > schedule
                                              > > > > > > allowances.
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > >
                                              > > > >
                                              > > >
                                              > >
                                              >
                                              http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                              > > > > orm.pd
                                              > > > > > > f
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > > Linda Walker
                                              > > > > > >
                                              > > > > > > Practice Managers Resource & Networking
                                              > > > > Community
                                              > > > > > > <http://www.billerswebsite.com>
                                              > > > > > > http://www.billerswebsite.com
                                              > > > > > > A division of K&L Media, LLC
                                              > > > > > > <http://www.klmediallc.com>
                                              > > > > > > http://www.klmediallc.com
                                              > > > > > >
                                              > > > > > > Website Design & Management for the Medical
                                              > > > > Services
                                              > > > > > > Industry
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > > From: MedicalBillers@yahoogroups.com
                                              > <mailto:MedicalBillers%40yahoogroups.com>
                                              > > <mailto:MedicalBillers%40yahoogroups.com>
                                              > > > > > > [mailto:MedicalBillers@yahoogroups.com
                                              > <mailto:MedicalBillers%40yahoogroups.com>
                                              > > <mailto:MedicalBillers%40yahoogroups.com> ]
                                              > > > > > > On Behalf Of debbie brosnan
                                              > > > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                              > > > > > > To: MedicalBillers@yahoogroups.com
                                              > <mailto:MedicalBillers%40yahoogroups.com>
                                              > > <mailto:MedicalBillers%40yahoogroups.com>
                                              > > > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                              > > > > Schedule
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > > Tell us whats up??? Joktan I havent forgotten
                                              > > > > you
                                              > > > > > > about the appeals letter.
                                              > > > > > > Having problems putting my hands on one. I have
                                              > > > > > > letters for just about
                                              > > > > > > everything but timely filing.
                                              > > > > > >
                                              > > > > > > Joktan Edison <ejoktan@
                                              > > > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                              > > > > > > anyone help me on BCBS FL Fee Schedule. I would
                                              > > > > > > appreciate your help!!!!
                                              > > > > > >
                                              > > > > > >
                                              > > > > >
                                              > > > >
                                              > > > __________________________________________________________
                                              > > > > > > Never miss a thing. Make Yahoo your home page.
                                              > > > > > > http://www.yahoo.com/r/hs
                                              > > > > > >
                                              > > > > > > [Non-text portions of this message have been
                                              > > > > > > removed]
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > >
                                              > > > > > > [Non-text portions of this message have been
                                              > > > > > > removed]
                                              > > > > > >
                                              > > > > > >
                                              > > > > >
                                              > > > > >
                                              > > > > >
                                              > > > > >
                                              > > > >
                                              > > >
                                              > > __________________________________________________________
                                              > > > > ______________
                                              > > > > > Never miss a thing. Make Yahoo your home page.
                                              > > > > > http://www.yahoo.com/r/hs
                                              > > > > >
                                              > > > >
                                              > > > >
                                              > > > >
                                              > > >
                                              > > >
                                              > > >
                                              > > >
                                              > > >
                                              > > >
                                              > > >
                                              > > __________________________________________________________
                                              > > ______________
                                              > > > Looking for last minute shopping deals?
                                              > > > Find them fast with Yahoo! Search.
                                              > > http://tools.search.yahoo.com/newsearch/category.php?
                                              > category=shopping
                                              > > >
                                              > >
                                              > >
                                              > >
                                              > >
                                              > >
                                              > > [Non-text portions of this message have been removed]
                                              > >
                                              >
                                              >
                                              >
                                              >
                                              >
                                              > [Non-text portions of this message have been removed]
                                              >
                                            • Lin
                                              The original poster said: I want to bill the patient for the non ... The doctor could let the patient slide for the amount over R&C, however it is still
                                              Message 22 of 25 , Dec 13, 2007
                                              • 0 Attachment
                                                The original poster said:

                                                I want to bill the patient for the non
                                                > > > contracted rates rather than billing the patient the
                                                > > > entire amount.>>



                                                The doctor could let the patient slide for the amount over R&C, however it
                                                is still Illegal to "routinely" waive coinsurance/copayments"



                                                As for R&C, yes there are MANY publications on what providers charge in
                                                certain geographical locations. Insurance companies (I've worked for two of
                                                the top 5)

                                                Base U&C on the HIAA 90th percentile, so your books will come close but they
                                                are based on a different statistical measurement.

                                                R&C/U&C is not the same thing as A "fee schedule".



                                                If I read the scenario correctly (provider non par, doctor wants to only
                                                charge patient up to what BCBS allows) then this is not within compliancy as
                                                he is giving the patient a discount but the carrier is still paying based on
                                                the fee and the patient's policy. The patient's out-of-pocket expenses are
                                                considered "cost sharing" and a part of the contract between the policy
                                                holder and the insurer so there are two types of legal problems with that
                                                scenario.

                                                If the provider should become par with BCBS, the provider can then bill and
                                                collect only up to the BCBS allowable based on the fee schedule they will be
                                                given.

                                                U&C/R&C will not apply.



                                                Linda Walker

                                                Practice Managers Resource & Networking Community
                                                <http://www.billerswebsite.com> http://www.billerswebsite.com
                                                A division of K&L Media, LLC
                                                <http://www.klmediallc.com> http://www.klmediallc.com

                                                Website Design & Management for the Medical Services Industry







                                                From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
                                                On Behalf Of djgeisel
                                                Sent: Thursday, December 13, 2007 5:07 PM
                                                To: MedicalBillers@yahoogroups.com
                                                Subject: [MedicalBillers] Re: BCBS FL Fee Schedule



                                                I did not read anything about waiving co-ins or ded or co-pays, and
                                                if he or she wants to accept the co-ins on the U& C fees and write
                                                off his balance that is not fraudulent. If your fee is $50 and BC
                                                says the U& C according to them is $35 and the out of network co-ins
                                                is 30%, the patient pays the total U&C fee when they pay the $35 and
                                                the doctor is not fraudulent to write off the remaining $15. He is
                                                not under contract with the carrier. Also I googled reasonable and
                                                customary and the fee schedule is used synonomously with R& C and
                                                goes partly by geographical location, it is partly what most
                                                providers charge in that area and there are other mathematical
                                                calculations that can be made to arrive at those figures but there is
                                                almost no regulation on the matter. There is a publication we get in
                                                our office called "Fee Facts" That tells us what others charge in
                                                our locality for the same procedures we do. I still say call BC and
                                                ask questions. Diana
                                                --- In MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com> , "Lin" <italiandoll1967@...>
                                                wrote:
                                                >
                                                > U&C and R&C are not given out for the very reason she wants it <g>
                                                >
                                                > If you give the carrier the procedure code, your charge for the CPT
                                                code
                                                > they will either tell you yes it is within U&C or no it's not.
                                                >
                                                > They are not allowed to give out the figure unless it's via
                                                > pre-determination of benefits (cpt/charge)
                                                >
                                                >
                                                >
                                                > The reason the original poster wanted to know was because the
                                                doctor only
                                                > wants to collect up to the fee BCBS would allow (as though he was
                                                par) since
                                                > he is not par, routinely waiving the patients coinsurance/out-of-
                                                pocket is
                                                > fraudulent. That is why carriers don't release U&C so that
                                                providers are
                                                > not inclined to charge only R&C.
                                                >
                                                > The correct way for this to be done is the provider charges the
                                                normal fee
                                                > he charges for that procedure, patient pays in full at the time of
                                                visit and
                                                > the patient will be reimbursed up to U&C, minus any out-of-pocket.
                                                >
                                                >
                                                >
                                                >
                                                >
                                                > Linda Walker
                                                >
                                                > Practice Managers Resource & Networking Community
                                                > <http://www.billerswebsite.com> http://www.billerswebsite.com
                                                > A division of K&L Media, LLC
                                                > <http://www.klmediallc.com> http://www.klmediallc.com
                                                >
                                                > Website Design & Management for the Medical Services Industry
                                                >
                                                >
                                                >
                                                >
                                                >
                                                > From: MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                [mailto:MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com> ]
                                                > On Behalf Of djgeisel
                                                > Sent: Thursday, December 13, 2007 4:33 PM
                                                > To: MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > Subject: [MedicalBillers] Re: BCBS FL Fee Schedule
                                                >
                                                >
                                                >
                                                > So I think he wants to know how to find out what R&C/U&C is for
                                                that
                                                > state and provider. Do you know that or how to get that
                                                > information? Diana
                                                > --- In MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > <mailto:MedicalBillers%40yahoogroups.com> , "Lin"
                                                <italiandoll1967@>
                                                > wrote:
                                                > >
                                                > > Non Par will go by R&C/U&C and then the out of pocket is the
                                                > coinsurance of
                                                > > the plan. For example if the doctors charge is $50 and he is non
                                                > par, the
                                                > > patient might have 20% coinsurance and the R&C (not published nor
                                                > given out
                                                > > by any carrier) may be $48. In which case the patient is still
                                                > responsible
                                                > > for $25
                                                > >
                                                > > There is no fee schedule for NON par providers, it goes by the
                                                plan
                                                > benefit.
                                                > >
                                                > > If the provider was participating he would be entitled to the fee
                                                > schedule.
                                                > >
                                                > >
                                                > >
                                                > >
                                                > >
                                                > > Linda Walker
                                                > >
                                                > > Practice Managers Resource & Networking Community
                                                > > <http://www.billerswebsite.com> http://www.billerswebsite.com
                                                > > A division of K&L Media, LLC
                                                > > <http://www.klmediallc.com> http://www.klmediallc.com
                                                > >
                                                > > Website Design & Management for the Medical Services Industry
                                                > >
                                                > >
                                                > >
                                                > >
                                                > >
                                                > > From: MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > <mailto:MedicalBillers%40yahoogroups.com>
                                                > [mailto:MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > <mailto:MedicalBillers%40yahoogroups.com> ]
                                                > > On Behalf Of djgeisel
                                                > > Sent: Thursday, December 13, 2007 4:01 PM
                                                > > To: MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > <mailto:MedicalBillers%40yahoogroups.com>
                                                > > Subject: [MedicalBillers] Re: BCBS FL Fee Schedule
                                                > >
                                                > >
                                                > >
                                                > > You could wait for the EOB or 835 and post from that only the
                                                > amount
                                                > > paid to the patient, but if you are not par maybe you don't even
                                                > get
                                                > > an EOB? Many carriers post thier fee schedule on the web site and
                                                > > the out of network coverage is based on the fee schedule at a
                                                > lesser
                                                > > amount than in network...I think. We are in network (not with
                                                Fla)
                                                > > but I used to work for a doc who was out of network and I think
                                                > that
                                                > > is how it worked. If you know of a provider who is in network
                                                maybe
                                                > > you can get the fee schedule from them? Diana
                                                > >
                                                > > --- In MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > <mailto:MedicalBillers%40yahoogroups.com>
                                                > > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                                > <ejoktan@>
                                                > > wrote:
                                                > > >
                                                > > > Where do you I find them or else I have to request one
                                                > > > from the BCBS FL??? Moreover, my doctor is not
                                                > > > contracted with BCBS FL and most of the payment goes
                                                > > > to the patient? I want to bill the patient for the non
                                                > > > contracted rates rather than billing the patient the
                                                > > > entire amount. Hope you understand
                                                > > >
                                                > > >
                                                > > > --- djgeisel <djgeisel@> wrote:
                                                > > >
                                                > > > > Yes they all have a fe schedule! Diana
                                                > > > > --- In MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > <mailto:MedicalBillers%40yahoogroups.com>
                                                > > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                                > > > > <ejoktan@>
                                                > > > > wrote:
                                                > > > > >
                                                > > > > > Lin, Thanks for your reply. I did go through this
                                                > > > > form
                                                > > > > > earlier this morning, however Im wanting to know
                                                > > > > > whether BCBS FL insurance has any standard fee
                                                > > > > > schedule like Medicare has?
                                                > > > > >
                                                > > > > > Joktan
                                                > > > > >
                                                > > > > >
                                                > > > > > --- Lin <italiandoll1967@> wrote:
                                                > > > > >
                                                > > > > > > You can't get a full fee schedule unless your
                                                > > > > > > provider participates and in
                                                > > > > > > their packet should be a fee schedule. You can
                                                > > > > also
                                                > > > > > > send the attached via
                                                > > > > > > fax with specific codes to determine fee
                                                > > > > schedule
                                                > > > > > > allowances.
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > >
                                                > > > >
                                                > > >
                                                > >
                                                >
                                                http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                                > > > > orm.pd
                                                > > > > > > f
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > > Linda Walker
                                                > > > > > >
                                                > > > > > > Practice Managers Resource & Networking
                                                > > > > Community
                                                > > > > > > <http://www.billerswebsite.com>
                                                > > > > > > http://www.billerswebsite.com
                                                > > > > > > A division of K&L Media, LLC
                                                > > > > > > <http://www.klmediallc.com>
                                                > > > > > > http://www.klmediallc.com
                                                > > > > > >
                                                > > > > > > Website Design & Management for the Medical
                                                > > > > Services
                                                > > > > > > Industry
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > > From: MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > <mailto:MedicalBillers%40yahoogroups.com>
                                                > > <mailto:MedicalBillers%40yahoogroups.com>
                                                > > > > > > [mailto:MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > <mailto:MedicalBillers%40yahoogroups.com>
                                                > > <mailto:MedicalBillers%40yahoogroups.com> ]
                                                > > > > > > On Behalf Of debbie brosnan
                                                > > > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                                > > > > > > To: MedicalBillers@yahoogroups.com
                                                <mailto:MedicalBillers%40yahoogroups.com>
                                                > <mailto:MedicalBillers%40yahoogroups.com>
                                                > > <mailto:MedicalBillers%40yahoogroups.com>
                                                > > > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                                > > > > Schedule
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > > Tell us whats up??? Joktan I havent forgotten
                                                > > > > you
                                                > > > > > > about the appeals letter.
                                                > > > > > > Having problems putting my hands on one. I have
                                                > > > > > > letters for just about
                                                > > > > > > everything but timely filing.
                                                > > > > > >
                                                > > > > > > Joktan Edison <ejoktan@
                                                > > > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                                > > > > > > anyone help me on BCBS FL Fee Schedule. I would
                                                > > > > > > appreciate your help!!!!
                                                > > > > > >
                                                > > > > > >
                                                > > > > >
                                                > > > >
                                                > > > __________________________________________________________
                                                > > > > > > Never miss a thing. Make Yahoo your home page.
                                                > > > > > > http://www.yahoo.com/r/hs
                                                > > > > > >
                                                > > > > > > [Non-text portions of this message have been
                                                > > > > > > removed]
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > >
                                                > > > > > > [Non-text portions of this message have been
                                                > > > > > > removed]
                                                > > > > > >
                                                > > > > > >
                                                > > > > >
                                                > > > > >
                                                > > > > >
                                                > > > > >
                                                > > > >
                                                > > >
                                                > > __________________________________________________________
                                                > > > > ______________
                                                > > > > > Never miss a thing. Make Yahoo your home page.
                                                > > > > > http://www.yahoo.com/r/hs
                                                > > > > >
                                                > > > >
                                                > > > >
                                                > > > >
                                                > > >
                                                > > >
                                                > > >
                                                > > >
                                                > > >
                                                > > >
                                                > > >
                                                > > __________________________________________________________
                                                > > ______________
                                                > > > Looking for last minute shopping deals?
                                                > > > Find them fast with Yahoo! Search.
                                                > > http://tools.search.yahoo.com/newsearch/category.php?
                                                > category=shopping
                                                > > >
                                                > >
                                                > >
                                                > >
                                                > >
                                                > >
                                                > > [Non-text portions of this message have been removed]
                                                > >
                                                >
                                                >
                                                >
                                                >
                                                >
                                                > [Non-text portions of this message have been removed]
                                                >





                                                [Non-text portions of this message have been removed]
                                              • djgeisel
                                                When I was working for an out of network provider, I actually asked the carrier when I called for benefits, if there was any problem with writing off the
                                                Message 23 of 25 , Dec 13, 2007
                                                • 0 Attachment
                                                  When I was working for an out of network provider, I actually asked
                                                  the carrier when I called for benefits, if there was any problem with
                                                  writing off the amount over the scheduled amount and they said, No
                                                  that is up to the provider since he is not under contract with the
                                                  carrier. They cannot use it as an inducement to get patients to come
                                                  to them however(ie: advertise co-pays waived). I also had no problem
                                                  getting them to give me fee schedules. Now that was 10yrs ago and
                                                  perhaps things have tightened up since then. Our office is par with
                                                  almost everybody. Of course par or not we all have to abide by
                                                  Medicare's rules! That is the government! Medicare/CMS has a
                                                  formula for calculating reasonable and custumary. Diana

                                                  --- In MedicalBillers@yahoogroups.com, "Lin" <italiandoll1967@...>
                                                  wrote:
                                                  >
                                                  > The original poster said:
                                                  >
                                                  > I want to bill the patient for the non
                                                  > > > > contracted rates rather than billing the patient the
                                                  > > > > entire amount.>>
                                                  >
                                                  >
                                                  >
                                                  > The doctor could let the patient slide for the amount over R&C,
                                                  however it
                                                  > is still Illegal to "routinely" waive coinsurance/copayments"
                                                  >
                                                  >
                                                  >
                                                  > As for R&C, yes there are MANY publications on what providers
                                                  charge in
                                                  > certain geographical locations. Insurance companies (I've worked
                                                  for two of
                                                  > the top 5)
                                                  >
                                                  > Base U&C on the HIAA 90th percentile, so your books will come close
                                                  but they
                                                  > are based on a different statistical measurement.
                                                  >
                                                  > R&C/U&C is not the same thing as A "fee schedule".
                                                  >
                                                  >
                                                  >
                                                  > If I read the scenario correctly (provider non par, doctor wants to
                                                  only
                                                  > charge patient up to what BCBS allows) then this is not within
                                                  compliancy as
                                                  > he is giving the patient a discount but the carrier is still paying
                                                  based on
                                                  > the fee and the patient's policy. The patient's out-of-pocket
                                                  expenses are
                                                  > considered "cost sharing" and a part of the contract between the
                                                  policy
                                                  > holder and the insurer so there are two types of legal problems
                                                  with that
                                                  > scenario.
                                                  >
                                                  > If the provider should become par with BCBS, the provider can then
                                                  bill and
                                                  > collect only up to the BCBS allowable based on the fee schedule
                                                  they will be
                                                  > given.
                                                  >
                                                  > U&C/R&C will not apply.
                                                  >
                                                  >
                                                  >
                                                  > Linda Walker
                                                  >
                                                  > Practice Managers Resource & Networking Community
                                                  > <http://www.billerswebsite.com> http://www.billerswebsite.com
                                                  > A division of K&L Media, LLC
                                                  > <http://www.klmediallc.com> http://www.klmediallc.com
                                                  >
                                                  > Website Design & Management for the Medical Services Industry
                                                  >
                                                  >
                                                  >
                                                  >
                                                  >
                                                  >
                                                  >
                                                  > From: MedicalBillers@yahoogroups.com
                                                  [mailto:MedicalBillers@yahoogroups.com]
                                                  > On Behalf Of djgeisel
                                                  > Sent: Thursday, December 13, 2007 5:07 PM
                                                  > To: MedicalBillers@yahoogroups.com
                                                  > Subject: [MedicalBillers] Re: BCBS FL Fee Schedule
                                                  >
                                                  >
                                                  >
                                                  > I did not read anything about waiving co-ins or ded or co-pays, and
                                                  > if he or she wants to accept the co-ins on the U& C fees and write
                                                  > off his balance that is not fraudulent. If your fee is $50 and BC
                                                  > says the U& C according to them is $35 and the out of network co-
                                                  ins
                                                  > is 30%, the patient pays the total U&C fee when they pay the $35
                                                  and
                                                  > the doctor is not fraudulent to write off the remaining $15. He is
                                                  > not under contract with the carrier. Also I googled reasonable and
                                                  > customary and the fee schedule is used synonomously with R& C and
                                                  > goes partly by geographical location, it is partly what most
                                                  > providers charge in that area and there are other mathematical
                                                  > calculations that can be made to arrive at those figures but there
                                                  is
                                                  > almost no regulation on the matter. There is a publication we get
                                                  in
                                                  > our office called "Fee Facts" That tells us what others charge in
                                                  > our locality for the same procedures we do. I still say call BC and
                                                  > ask questions. Diana
                                                  > --- In MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com> , "Lin"
                                                  <italiandoll1967@>
                                                  > wrote:
                                                  > >
                                                  > > U&C and R&C are not given out for the very reason she wants it <g>
                                                  > >
                                                  > > If you give the carrier the procedure code, your charge for the
                                                  CPT
                                                  > code
                                                  > > they will either tell you yes it is within U&C or no it's not.
                                                  > >
                                                  > > They are not allowed to give out the figure unless it's via
                                                  > > pre-determination of benefits (cpt/charge)
                                                  > >
                                                  > >
                                                  > >
                                                  > > The reason the original poster wanted to know was because the
                                                  > doctor only
                                                  > > wants to collect up to the fee BCBS would allow (as though he was
                                                  > par) since
                                                  > > he is not par, routinely waiving the patients coinsurance/out-of-
                                                  > pocket is
                                                  > > fraudulent. That is why carriers don't release U&C so that
                                                  > providers are
                                                  > > not inclined to charge only R&C.
                                                  > >
                                                  > > The correct way for this to be done is the provider charges the
                                                  > normal fee
                                                  > > he charges for that procedure, patient pays in full at the time
                                                  of
                                                  > visit and
                                                  > > the patient will be reimbursed up to U&C, minus any out-of-
                                                  pocket.
                                                  > >
                                                  > >
                                                  > >
                                                  > >
                                                  > >
                                                  > > Linda Walker
                                                  > >
                                                  > > Practice Managers Resource & Networking Community
                                                  > > <http://www.billerswebsite.com> http://www.billerswebsite.com
                                                  > > A division of K&L Media, LLC
                                                  > > <http://www.klmediallc.com> http://www.klmediallc.com
                                                  > >
                                                  > > Website Design & Management for the Medical Services Industry
                                                  > >
                                                  > >
                                                  > >
                                                  > >
                                                  > >
                                                  > > From: MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > [mailto:MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com> ]
                                                  > > On Behalf Of djgeisel
                                                  > > Sent: Thursday, December 13, 2007 4:33 PM
                                                  > > To: MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > Subject: [MedicalBillers] Re: BCBS FL Fee Schedule
                                                  > >
                                                  > >
                                                  > >
                                                  > > So I think he wants to know how to find out what R&C/U&C is for
                                                  > that
                                                  > > state and provider. Do you know that or how to get that
                                                  > > information? Diana
                                                  > > --- In MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > <mailto:MedicalBillers%40yahoogroups.com> , "Lin"
                                                  > <italiandoll1967@>
                                                  > > wrote:
                                                  > > >
                                                  > > > Non Par will go by R&C/U&C and then the out of pocket is the
                                                  > > coinsurance of
                                                  > > > the plan. For example if the doctors charge is $50 and he is
                                                  non
                                                  > > par, the
                                                  > > > patient might have 20% coinsurance and the R&C (not published
                                                  nor
                                                  > > given out
                                                  > > > by any carrier) may be $48. In which case the patient is still
                                                  > > responsible
                                                  > > > for $25
                                                  > > >
                                                  > > > There is no fee schedule for NON par providers, it goes by the
                                                  > plan
                                                  > > benefit.
                                                  > > >
                                                  > > > If the provider was participating he would be entitled to the
                                                  fee
                                                  > > schedule.
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > > Linda Walker
                                                  > > >
                                                  > > > Practice Managers Resource & Networking Community
                                                  > > > <http://www.billerswebsite.com> http://www.billerswebsite.com
                                                  > > > A division of K&L Media, LLC
                                                  > > > <http://www.klmediallc.com> http://www.klmediallc.com
                                                  > > >
                                                  > > > Website Design & Management for the Medical Services Industry
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > > From: MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > [mailto:MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > <mailto:MedicalBillers%40yahoogroups.com> ]
                                                  > > > On Behalf Of djgeisel
                                                  > > > Sent: Thursday, December 13, 2007 4:01 PM
                                                  > > > To: MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > > Subject: [MedicalBillers] Re: BCBS FL Fee Schedule
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > > You could wait for the EOB or 835 and post from that only the
                                                  > > amount
                                                  > > > paid to the patient, but if you are not par maybe you don't
                                                  even
                                                  > > get
                                                  > > > an EOB? Many carriers post thier fee schedule on the web site
                                                  and
                                                  > > > the out of network coverage is based on the fee schedule at a
                                                  > > lesser
                                                  > > > amount than in network...I think. We are in network (not with
                                                  > Fla)
                                                  > > > but I used to work for a doc who was out of network and I think
                                                  > > that
                                                  > > > is how it worked. If you know of a provider who is in network
                                                  > maybe
                                                  > > > you can get the fee schedule from them? Diana
                                                  > > >
                                                  > > > --- In MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                                  > > <ejoktan@>
                                                  > > > wrote:
                                                  > > > >
                                                  > > > > Where do you I find them or else I have to request one
                                                  > > > > from the BCBS FL??? Moreover, my doctor is not
                                                  > > > > contracted with BCBS FL and most of the payment goes
                                                  > > > > to the patient? I want to bill the patient for the non
                                                  > > > > contracted rates rather than billing the patient the
                                                  > > > > entire amount. Hope you understand
                                                  > > > >
                                                  > > > >
                                                  > > > > --- djgeisel <djgeisel@> wrote:
                                                  > > > >
                                                  > > > > > Yes they all have a fe schedule! Diana
                                                  > > > > > --- In MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > > <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                                  > > > > > <ejoktan@>
                                                  > > > > > wrote:
                                                  > > > > > >
                                                  > > > > > > Lin, Thanks for your reply. I did go through this
                                                  > > > > > form
                                                  > > > > > > earlier this morning, however Im wanting to know
                                                  > > > > > > whether BCBS FL insurance has any standard fee
                                                  > > > > > > schedule like Medicare has?
                                                  > > > > > >
                                                  > > > > > > Joktan
                                                  > > > > > >
                                                  > > > > > >
                                                  > > > > > > --- Lin <italiandoll1967@> wrote:
                                                  > > > > > >
                                                  > > > > > > > You can't get a full fee schedule unless your
                                                  > > > > > > > provider participates and in
                                                  > > > > > > > their packet should be a fee schedule. You can
                                                  > > > > > also
                                                  > > > > > > > send the attached via
                                                  > > > > > > > fax with specific codes to determine fee
                                                  > > > > > schedule
                                                  > > > > > > > allowances.
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > >
                                                  > > > > >
                                                  > > > >
                                                  > > >
                                                  > >
                                                  >
                                                  http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                                  > > > > > orm.pd
                                                  > > > > > > > f
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > > Linda Walker
                                                  > > > > > > >
                                                  > > > > > > > Practice Managers Resource & Networking
                                                  > > > > > Community
                                                  > > > > > > > <http://www.billerswebsite.com>
                                                  > > > > > > > http://www.billerswebsite.com
                                                  > > > > > > > A division of K&L Media, LLC
                                                  > > > > > > > <http://www.klmediallc.com>
                                                  > > > > > > > http://www.klmediallc.com
                                                  > > > > > > >
                                                  > > > > > > > Website Design & Management for the Medical
                                                  > > > > > Services
                                                  > > > > > > > Industry
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > > From: MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > > > > > > [mailto:MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > > <mailto:MedicalBillers%40yahoogroups.com> ]
                                                  > > > > > > > On Behalf Of debbie brosnan
                                                  > > > > > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                                  > > > > > > > To: MedicalBillers@yahoogroups.com
                                                  > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > > <mailto:MedicalBillers%40yahoogroups.com>
                                                  > > > > > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                                  > > > > > Schedule
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > > Tell us whats up??? Joktan I havent forgotten
                                                  > > > > > you
                                                  > > > > > > > about the appeals letter.
                                                  > > > > > > > Having problems putting my hands on one. I have
                                                  > > > > > > > letters for just about
                                                  > > > > > > > everything but timely filing.
                                                  > > > > > > >
                                                  > > > > > > > Joktan Edison <ejoktan@
                                                  > > > > > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                                  > > > > > > > anyone help me on BCBS FL Fee Schedule. I would
                                                  > > > > > > > appreciate your help!!!!
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > >
                                                  > > > > >
                                                  > > > > __________________________________________________________
                                                  > > > > > > > Never miss a thing. Make Yahoo your home page.
                                                  > > > > > > > http://www.yahoo.com/r/hs
                                                  > > > > > > >
                                                  > > > > > > > [Non-text portions of this message have been
                                                  > > > > > > > removed]
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > > > [Non-text portions of this message have been
                                                  > > > > > > > removed]
                                                  > > > > > > >
                                                  > > > > > > >
                                                  > > > > > >
                                                  > > > > > >
                                                  > > > > > >
                                                  > > > > > >
                                                  > > > > >
                                                  > > > >
                                                  > > > __________________________________________________________
                                                  > > > > > ______________
                                                  > > > > > > Never miss a thing. Make Yahoo your home page.
                                                  > > > > > > http://www.yahoo.com/r/hs
                                                  > > > > > >
                                                  > > > > >
                                                  > > > > >
                                                  > > > > >
                                                  > > > >
                                                  > > > >
                                                  > > > >
                                                  > > > >
                                                  > > > >
                                                  > > > >
                                                  > > > >
                                                  > > > __________________________________________________________
                                                  > > > ______________
                                                  > > > > Looking for last minute shopping deals?
                                                  > > > > Find them fast with Yahoo! Search.
                                                  > > > http://tools.search.yahoo.com/newsearch/category.php?
                                                  > > category=shopping
                                                  > > > >
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > >
                                                  > > > [Non-text portions of this message have been removed]
                                                  > > >
                                                  > >
                                                  > >
                                                  > >
                                                  > >
                                                  > >
                                                  > > [Non-text portions of this message have been removed]
                                                  > >
                                                  >
                                                  >
                                                  >
                                                  >
                                                  >
                                                  > [Non-text portions of this message have been removed]
                                                  >
                                                • Sarah1230836@cs.com
                                                  One of the practices that I work with has a similar arrangement with BCBS of Florida patients. The physician was dropped by BCBS and has been unsuccessful in
                                                  Message 24 of 25 , Dec 13, 2007
                                                  • 0 Attachment
                                                    One of the practices that I work with has a similar arrangement with BCBS of Florida patients. The physician was dropped by BCBS and has been unsuccessful in being added back into the network. I require the patient to bring in or fax the EOB before I do any adjustments. If the patient does not provide the EOB, then the patient is responsible for the standard fee.

                                                    Sarah Nachimson, CPC

                                                    "djgeisel" <djgeisel@...> wrote:

                                                    >You could wait for the EOB or 835 and post from that only the amount
                                                    >paid to the patient, but if you are not par maybe you don't even get
                                                    >an EOB? Many carriers post thier fee schedule on the web site and
                                                    >the out of network coverage is based on the fee schedule at a lesser
                                                    >amount than in network...I think. We are in network (not with Fla)
                                                    >but I used to work for a doc who was out of network and I think that
                                                    >is how it worked. If you know of a provider who is in network maybe
                                                    >you can get the fee schedule from them? Diana
                                                    >
                                                    >--- In MedicalBillers@yahoogroups.com, Joktan Edison <ejoktan@...>
                                                    >wrote:
                                                    >>
                                                    >> Where do you I find them or else I have to request one
                                                    >> from the BCBS FL??? Moreover, my doctor is not
                                                    >> contracted with BCBS FL and most of the payment goes
                                                    >> to the patient? I want to bill the patient for the non
                                                    >> contracted rates rather than billing the patient the
                                                    >> entire amount. Hope you understand
                                                    >>
                                                    >>
                                                    >> --- djgeisel <djgeisel@...> wrote:
                                                    >>
                                                    >> > Yes they all have a fe schedule! Diana
                                                    >> > --- In MedicalBillers@yahoogroups.com, Joktan Edison
                                                    >> > <ejoktan@>
                                                    >> > wrote:
                                                    >> > >
                                                    >> > > Lin, Thanks for your reply. I did go through this
                                                    >> > form
                                                    >> > > earlier this morning, however Im wanting to know
                                                    >> > > whether BCBS FL insurance has any standard fee
                                                    >> > > schedule like Medicare has?
                                                    >> > >
                                                    >> > > Joktan
                                                    >> > >
                                                    >> > >
                                                    >> > > --- Lin <italiandoll1967@> wrote:
                                                    >> > >
                                                    >> > > > You can't get a full fee schedule unless your
                                                    >> > > > provider participates and in
                                                    >> > > > their packet should be a fee schedule. You can
                                                    >> > also
                                                    >> > > > send the attached via
                                                    >> > > > fax with specific codes to determine fee
                                                    >> > schedule
                                                    >> > > > allowances.
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > >
                                                    >> >
                                                    >>
                                                    >http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                                    >> > orm.pd
                                                    >> > > > f
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > > Linda Walker
                                                    >> > > >
                                                    >> > > > Practice Managers Resource & Networking
                                                    >> > Community
                                                    >> > > > <http://www.billerswebsite.com>
                                                    >> > > > http://www.billerswebsite.com
                                                    >> > > > A division of K&L Media, LLC
                                                    >> > > > <http://www.klmediallc.com>
                                                    >> > > > http://www.klmediallc.com
                                                    >> > > >
                                                    >> > > > Website Design & Management for the Medical
                                                    >> > Services
                                                    >> > > > Industry
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > > From: MedicalBillers@yahoogroups.com
                                                    >> > > > [mailto:MedicalBillers@yahoogroups.com]
                                                    >> > > > On Behalf Of debbie brosnan
                                                    >> > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                                    >> > > > To: MedicalBillers@yahoogroups.com
                                                    >> > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                                    >> > Schedule
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > > Tell us whats up??? Joktan I havent forgotten
                                                    >> > you
                                                    >> > > > about the appeals letter.
                                                    >> > > > Having problems putting my hands on one. I have
                                                    >> > > > letters for just about
                                                    >> > > > everything but timely filing.
                                                    >> > > >
                                                    >> > > > Joktan Edison <ejoktan@
                                                    >> > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                                    >> > > > anyone help me on BCBS FL Fee Schedule. I would
                                                    >> > > > appreciate your help!!!!
                                                    >> > > >
                                                    >> > > >
                                                    >> > >
                                                    >> >
                                                    >> __________________________________________________________
                                                    >> > > > Never miss a thing. Make Yahoo your home page.
                                                    >> > > > http://www.yahoo.com/r/hs
                                                    >> > > >
                                                    >> > > > [Non-text portions of this message have been
                                                    >> > > > removed]
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > >
                                                    >> > > > [Non-text portions of this message have been
                                                    >> > > > removed]
                                                    >> > > >
                                                    >> > > >
                                                    >> > >
                                                    >> > >
                                                    >> > >
                                                    >> > >
                                                    >> >
                                                    >>
                                                    >______________________________________________________________________
                                                    >> > ______________
                                                    >> > > Never miss a thing. Make Yahoo your home page.
                                                    >> > > http://www.yahoo.com/r/hs
                                                    >> > >
                                                    >> >
                                                    >> >
                                                    >> >
                                                    >>
                                                    >>
                                                    >>
                                                    >>
                                                    >>
                                                    >>
                                                    >>
                                                    >______________________________________________________________________
                                                    >______________
                                                    >> Looking for last minute shopping deals?
                                                    >> Find them fast with Yahoo! Search.
                                                    >http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                                                    >>
                                                    >
                                                    >
                                                  • Lin
                                                    So patients are being given a discount routinely without financial hardship arrangements in the file? In your situation there might be some leadway from this
                                                    Message 25 of 25 , Dec 13, 2007
                                                    • 0 Attachment
                                                      So patients are being given a discount routinely without financial hardship
                                                      arrangements in the file?

                                                      In your situation there might be some leadway from this being fraud if the
                                                      patients were under the doctors care prior to him being dropped, in that
                                                      instance the doctor could set forth in writing denouncing his participation
                                                      and letting patients know their out-of-pocket by a certain time frame.
                                                      Usually BCBS has like a 90 day period after they drop someone though, so I
                                                      wouldn’t go beyond that 90 days.





                                                      Linda Walker

                                                      Practice Managers Resource & Networking Community
                                                      <http://www.billerswebsite.com> http://www.billerswebsite.com
                                                      A division of K&L Media, LLC
                                                      <http://www.klmediallc.com> http://www.klmediallc.com

                                                      Website Design & Management for the Medical Services Industry





                                                      From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
                                                      On Behalf Of Sarah1230836@...
                                                      Sent: Thursday, December 13, 2007 10:43 PM
                                                      To: MedicalBillers@yahoogroups.com
                                                      Subject: RE: [MedicalBillers] Re: BCBS FL Fee Schedule



                                                      One of the practices that I work with has a similar arrangement with BCBS of
                                                      Florida patients. The physician was dropped by BCBS and has been
                                                      unsuccessful in being added back into the network. I require the patient to
                                                      bring in or fax the EOB before I do any adjustments. If the patient does not
                                                      provide the EOB, then the patient is responsible for the standard fee.

                                                      Sarah Nachimson, CPC

                                                      "djgeisel" <djgeisel@... <mailto:djgeisel%40charter.net> > wrote:

                                                      >You could wait for the EOB or 835 and post from that only the amount
                                                      >paid to the patient, but if you are not par maybe you don't even get
                                                      >an EOB? Many carriers post thier fee schedule on the web site and
                                                      >the out of network coverage is based on the fee schedule at a lesser
                                                      >amount than in network...I think. We are in network (not with Fla)
                                                      >but I used to work for a doc who was out of network and I think that
                                                      >is how it worked. If you know of a provider who is in network maybe
                                                      >you can get the fee schedule from them? Diana
                                                      >
                                                      >--- In MedicalBillers@yahoogroups.com
                                                      <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison <ejoktan@...>
                                                      >wrote:
                                                      >>
                                                      >> Where do you I find them or else I have to request one
                                                      >> from the BCBS FL??? Moreover, my doctor is not
                                                      >> contracted with BCBS FL and most of the payment goes
                                                      >> to the patient? I want to bill the patient for the non
                                                      >> contracted rates rather than billing the patient the
                                                      >> entire amount. Hope you understand
                                                      >>
                                                      >>
                                                      >> --- djgeisel <djgeisel@...> wrote:
                                                      >>
                                                      >> > Yes they all have a fe schedule! Diana
                                                      >> > --- In MedicalBillers@yahoogroups.com
                                                      <mailto:MedicalBillers%40yahoogroups.com> , Joktan Edison
                                                      >> > <ejoktan@>
                                                      >> > wrote:
                                                      >> > >
                                                      >> > > Lin, Thanks for your reply. I did go through this
                                                      >> > form
                                                      >> > > earlier this morning, however Im wanting to know
                                                      >> > > whether BCBS FL insurance has any standard fee
                                                      >> > > schedule like Medicare has?
                                                      >> > >
                                                      >> > > Joktan
                                                      >> > >
                                                      >> > >
                                                      >> > > --- Lin <italiandoll1967@> wrote:
                                                      >> > >
                                                      >> > > > You can't get a full fee schedule unless your
                                                      >> > > > provider participates and in
                                                      >> > > > their packet should be a fee schedule. You can
                                                      >> > also
                                                      >> > > > send the attached via
                                                      >> > > > fax with specific codes to determine fee
                                                      >> > schedule
                                                      >> > > > allowances.
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > >
                                                      >> >
                                                      >>
                                                      >http://www.bcbsfl.com/es/DocumentLibrary/Providers/FeeScheduleRequestF
                                                      >> > orm.pd
                                                      >> > > > f
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > > Linda Walker
                                                      >> > > >
                                                      >> > > > Practice Managers Resource & Networking
                                                      >> > Community
                                                      >> > > > <http://www.billerswebsite.com>
                                                      >> > > > http://www.billerswebsite.com
                                                      >> > > > A division of K&L Media, LLC
                                                      >> > > > <http://www.klmediallc.com>
                                                      >> > > > http://www.klmediallc.com
                                                      >> > > >
                                                      >> > > > Website Design & Management for the Medical
                                                      >> > Services
                                                      >> > > > Industry
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > > From: MedicalBillers@yahoogroups.com
                                                      <mailto:MedicalBillers%40yahoogroups.com>
                                                      >> > > > [mailto:MedicalBillers@yahoogroups.com
                                                      <mailto:MedicalBillers%40yahoogroups.com> ]
                                                      >> > > > On Behalf Of debbie brosnan
                                                      >> > > > Sent: Wednesday, December 05, 2007 3:29 PM
                                                      >> > > > To: MedicalBillers@yahoogroups.com
                                                      <mailto:MedicalBillers%40yahoogroups.com>
                                                      >> > > > Subject: Re: [MedicalBillers] BCBS FL Fee
                                                      >> > Schedule
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > > Tell us whats up??? Joktan I havent forgotten
                                                      >> > you
                                                      >> > > > about the appeals letter.
                                                      >> > > > Having problems putting my hands on one. I have
                                                      >> > > > letters for just about
                                                      >> > > > everything but timely filing.
                                                      >> > > >
                                                      >> > > > Joktan Edison <ejoktan@
                                                      >> > > > <mailto:ejoktan%40yahoo.com> > wrote: Could
                                                      >> > > > anyone help me on BCBS FL Fee Schedule. I would
                                                      >> > > > appreciate your help!!!!
                                                      >> > > >
                                                      >> > > >
                                                      >> > >
                                                      >> >
                                                      >> __________________________________________________________
                                                      >> > > > Never miss a thing. Make Yahoo your home page.
                                                      >> > > > http://www.yahoo.com/r/hs
                                                      >> > > >
                                                      >> > > > [Non-text portions of this message have been
                                                      >> > > > removed]
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > >
                                                      >> > > > [Non-text portions of this message have been
                                                      >> > > > removed]
                                                      >> > > >
                                                      >> > > >
                                                      >> > >
                                                      >> > >
                                                      >> > >
                                                      >> > >
                                                      >> >
                                                      >>
                                                      >__________________________________________________________
                                                      >> > ______________
                                                      >> > > Never miss a thing. Make Yahoo your home page.
                                                      >> > > http://www.yahoo.com/r/hs
                                                      >> > >
                                                      >> >
                                                      >> >
                                                      >> >
                                                      >>
                                                      >>
                                                      >>
                                                      >>
                                                      >>
                                                      >>
                                                      >>
                                                      >__________________________________________________________
                                                      >______________
                                                      >> Looking for last minute shopping deals?
                                                      >> Find them fast with Yahoo! Search.
                                                      >http://tools.search.yahoo.com/newsearch/category.php?category=shopping
                                                      >>
                                                      >
                                                      >





                                                      [Non-text portions of this message have been removed]
                                                    Your message has been successfully submitted and would be delivered to recipients shortly.