BC Advantage - 2007 Issue 9

Prevention of Silent PPOs

If a provider is not contracted with an insurance company, that provider is entitled to 100% of billed charges, so if an insurance company applies a discount, the provider can demand that the insurance company pay the balance of what is due or collect the balance from the patient.  If a provider is contracted with an insurance company, the discount taken by the insurance company may not be illegal or shady at all.  The language of the contract may have allowed the discount to be taken at all levels and this includes insurance companies that the provider...

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