Question

[ElizabethF]

What is the name of your state (only U.S. law)? South Carolina

Is it legal to change a insurance claim to make the insurance pay the claim? Example: The facilty bills as a facilty but the insurance will only pay if we bill as a office.What is the name of your state (only U.S. law)?

[Zigner]

Originally Posted by ElizabethF

What is the name of your state (only U.S. law)? South Carolina

Is it legal to change a insurance claim to make the insurance pay the claim? Example: The facilty bills as a facilty but the insurance will only pay if we bill as a office.What is the name of your state (only U.S. law)?

What is the difference between a facility and an office?

[lealea1005]

Originally Posted by Zigner

What is the difference between a facility and an office?

A facility would be a surgi-center, outpatient clinic, urgent care center, etc. The reimbursement rate is different in most cases.


OP: What is the provider's designation with the insurance company...office or facility?

[ecmst12]

It's only legal to change the designation if it's a proper designation. If you're a surgi-center, you can't legally bill as an office. It's possible this particular policy only covers some procedures in an office. It's the patient's job to find this out before hand and have it done at the right place. Of course, the provider can also inquire but they don't have access to as much information about the policy as the patient does.