Insurance & Sliding Scale fee/discount

Can a counselor bill insurance company normal rate (out of network provider)
and if patient cannot pay full charge at that time if they need sliding scale fee discount can they be discounted after insurance?

Or do you have to send the insurance the sliding scale discounted fee?

No!

You should not discount the patient what you send to the insurance company! You can give them a discount on NON COVERED charges for "Cash Payments" or "Income Qualifying Reasons" but only if it is NOT COVERED. Any COVERED services that pay only so much, you are required to charge the deductable and copays. Any amount over the allowed amount you can adjust to match the allowed amount as a courtisy when Out of Network, and you are required to when in network, but other than that you must charge them their responsibility amounts.

discount

does that go for internal med too?