Guest guest Posted May 17, 2006 Report Share Posted May 17, 2006 Hi all, Today I've been reviewing our EOBs and noticed that a couple of PPO plans we aren't contracted with are reducing the amounts we bill to a lower figure that they call the " usual and customary fee " , and then pay us on this basis. They didn't pass on the difference as part of the patient's responsibility. They just wrote it off. Now I understand that if we were a contracted provider we have to adhere to allowable rates, but in these cases we aren't a contracted provider! I googled " usual and customary " and got a quick impression that " usual and customary " isn't usual and customary at all. It varies from insurer to insurer based on their own formulas. It is in essence another way to lower the amount paid to the provider. Is it possible to contact the insurer and demand payment for the amount we actually billed? Has anyone tried this and had any success? Mendelssohn Practice Manager Mendelssohn, MD, FACOG Obstetrics & Gynecology Quote Link to comment Share on other sites More sharing options...
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