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Thread Topic: Anesthesia billing
Topic Originator: Victor
Post Date July 22, 2008 @ 3:54 PM
Anesthesia billing

July 22, 2008 @ 3:54 PM Reply  |  Email Friend   |  |Print  |  Top

Hi All,

I work for a group of Anesthesiologists based in NY all of them are non-participating and the only thing I bill for is their professional services CPT 00740 and CPT 00810.
I like to know if all our Anesthesiologists participate with insurance, at what rate our claims will be paid.


steve verno
July 23, 2008 @ 4:34 AM Reply  |  Email Friend   |  |Print  |  Top

Other than medicare or Medicaid, what an insurance company pays is a mystery unless you happen to have a copy of the patients benefit manual.

For example, with one insurance company, it may say it pays out of network benefits at 60% of their UCR, which is unknown but the patient pays the other 40% and anything over UCR.  

Another insurance company may say there are no out of network benefits which means they pay nothing, nada, zip, bupkiss.

Another insurance company may say it pays 100% out of pocket expenses or the benefit is paid in full, which is 100% of your charges.

Again, each is different and as an out of network provider, payment is based on the contract with the member, which is why I look at the benefit manual.

steve verno
July 23, 2008 @ 10:28 AM Reply  |  Email Friend   |  |Print  |  Top

After re-reading, when a group is Par, how the carrier pays is per the par agreement.  The agreement should state that the claim is paid at the Group For example, with Aetna, the contract may say the claim is paid at 80% of the Medicare allowable  With Cigna, the contract may say the claim may be paid at 70% of billed charges,

Now, the carrier may have a separate fee for the procedure but the contract must specify that it is ageed that payment is per this fee schedule.

The contract must also specify how the claim is to be paid when a new provider is hired.  I should also specify payment when a provider does services for thi group and the provider has his own practice and  his own contract.

With one insurance company we specified that when a provider has his own practtice and works for us, that providers contract is nul and void and all our claims are paid per ur agreed amount using the grou tax id number as the basis for payment.  Claims for new providers were paid per the group contract, but you must specify all of this in the contract,  If not the carrier may pay as they wish.

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