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Apr 25, 2017
11:56:33am
BYUfan92 All-American
FYi - this is not the providers issue. MANY insurances don't provide the fee
schedule in advance, well specifically they don't provide a fee for all codes. I have HUNDREDS of fee schedules in front of me at this moment for dozens of providers in numerous states and many do not have fees listed for various codes.

I'd say that 99% of the time the providers have a fee for every procedure they do, but the allowable by the insurance is not defined on many of those fee schedules. For instance some will say 90% of the providers fee, or 80% of the fee, or 80% of the MAC (maximum allowable charge, but they dont tell you what the MAC is until you get the payment back and see that you get 80% of whatever number they used)

Cigna does that, so does Humana. United Health too.
This message has been modified
Originally posted on Apr 25, 2017 at 11:56:33am
Message modified by BYUfan92 on Apr 25, 2017 at 1:12:58pm
BYUfan92
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BYUfan92
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