Chapter 13 Reality Check Billing and Reimbursement

Mrs. Ione was on a long vacation on the West coast when she unfortunately stepped off a curve incorrectly. Consequently, she was taken to the urgent care center where the physician’s assistant took an x-ray and added a walking boot to her ankle so she could get around until she got home and could see her orthopedist. When she signed out she was told by the front office staff that she saw a non-participating provider (nonPAR) and that full service fee was expected to be paid before she left. The bill itself was $1,500. The office staff explained their participating providers had not signed a contract with her insurance. She was assured that since she had Blue Cross/Blue Shield that she would be reimbursed for her payment to the provider, but that she would have to submit this to her insurance company herself.

Questions:

Do you think this is right or wrong? Have you been in such a situation where this has occurred? What did you do? Describe your experience.

Solution Preview

Reality Check Billing and Reimbursement

Full names:

Date:

The Situation

Mrs. Lone, having injured her ankle and taken to an urgent care center finds herself in a conundrum whereby her employer informs her of the situation with the health provider that took care of her, and that she had to take care of the $1,400 medical bill on her own.

Basing my discussion on the events leading to the insurer problem, Mrs. Lone had no idea that she saw a nonPAR. Therefore, the whole situation is wrong because the patient was admitted to urgent care and thus we cannot expect her to worry about whether the caregiver is a PAR or a nonPAR.

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