Can a physician charge a fee that cannot be filed to insurance?

Answer 1

The physician can charge a fee for any service they perform. Whether your insurance pays it or not is up to each individual policy. The physician may tell you up front if it is covered, but that is a courtesy. You are obligated to check with your insurance prior to your appointment to see if it is covered. 

Answer 2

No, because ALL fees can be "filed to insurance". It's then up to the insurance company to determine whether or not to cover each particular fee, if that's what you're trying to ask.  In many cases the patient personally agrees to be liable for the billed costs regardless of full insurance coverage of every line item.

Answer 3

Yes. some of our local dentists are charging a $ 10, $15 or $20 PPE fee perpatient per visit.

THAT is NOT covered by insurance.

Funny thing...these dentists and their assistants ALREADY wore lab coats, masks and gloves, LONG before covid spread from sea to sea.

They are taking gross advantage of their clients and profiting from the pandemic. There is NO WAY on earth that their mass purchases of PPC supplies cast them $10 to $20 per visit, per person. NO way. Just another way to make up financial losses from the shutdown.

And, of course insurance won't cover those trumped up charges.

Answer 4

What a physician can charge IS NOT controlled by what insurance will pay

Nuff Sed: Actually, in ALL cases the patient IS personally liable.

Answer 5

Yes, and this USUALLY involves an "out of network" Physician.

Answer 6

It depends on what you mean by "cannot be filed to insurance."   A doctor's office files a claim and the insurance company either pays or doesn't pay.

Answer 7

Of course. There are a number of reasons that insurance will not cover a doctors fee.

Answer 8

Yes.

Some ERs are contracting external doctors - so even if you check to see if the hospital the ambulance is taking you to is covered by your insurance,  you may suddenly find out that the doctor treating you in that ER is not.

America has one FUBAR health-care system.

Answer 9

Some doctors are now “concierge physicians”.  And they usually charge an annual fee for you to become one of their patients.  Also,  There are treatments that may not be covered by your insurance, but the Dr should make you aware of that before dispensing the treatment.  Sometimes insurance only covers a portion of a fee.  Make sure you understand exactly what your insurance covers and the percentages or flat rates they cover. 

Answer 10

They can charge any fee they want.  Whether or not your insurance will cover it is a separate issue.