Forum - Questions & Answers

Nov 10th, 2010 - lvaughan

Medicare Advantage Plans

We are a private radiology facility that does not participate with ANY insurance carriers except for traditional Medicare. I have been told that if we see these patients,we have to abide by the commercial carrier's rules and regs as a "deemed" provider.

Now I am reading information which indicates that in 2011, the "deemed' status will no longer exist.

My questions are:

1. Are we allowed to provide services to these patients if we are not contracted with the carrier?

2. If so, can we charge them our self pay pt fee since they are out of network

or

Are we obligated to accept the terms of the carrier

or

Do we need to charge no more than the traditional Medicare rate?

Thank you very much.



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