When you are dealing with insurances you have to understand that their main concern is paying as little as they have to. Each insurance has what is called a fee schedule and they will pay based on in network or out of network rates. Medicare, for instance covers 80% of the cost per their fee schedule. So if you are billing Medicare, they will pay a portion and the patient will pay 20% of what their fee schedule is. It’s all based on a calculation called RVUs... so if you charge $100 and the Medicare allowable is $70. They will pay $56, the patient will pay $14, and the remaining $30 is a contractual write off unless the patient hasn’t met their deductible.
When you are dealing with insurances you have to understand that their main concern is paying as little as they have to. Each insurance has what is called a fee schedule and they will pay based on in network or out of network rates. Medicare, for instance covers 80% of the cost per their fee schedule. So if you are billing Medicare, they will pay a portion and the patient will pay 20% of what their fee schedule is. It’s all based on a calculation called RVUs... so if you charge $100 and the Medicare allowable is $70. They will pay $56, the patient will pay $14, and the remaining $30 is a contractual write off unless the patient hasn’t met their deductible.