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HCR 230 Week 4 Discussion Question 1

HCR 230 Week 4 Discussion Question 1 - provider may not...

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Some of the financial advantages of being in the Tricare program include providers who participate agree to accept the allowable charge as payment in full for services. Some individual providers might decide whether to participate on a case-by-case basis. Some participating providers are required to file claims on behalf of patients. A provider who chooses not to participate might not charge more than 115 percent of the allowable charge. If a provider bills more than 115 percent, the patient might refuse to pay the excess amount. If the allowed charge for a procedure is $50.00, a nonparticipating
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Unformatted text preview: provider may not charge more than $57.50. If a nonparticipating provider were to charge $75.00 for the same procedure, the patient could refuse to pay the amount that exceeded 115 percent of the allowed amount. The difference of $17.50 would have to be written off by the provider. The patient would pay the cost-share, which is either 20 or 25 percent of a TRICARE term for the coinsurance, the amount that is the responsibility of the patient....
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