The MAPD PPO evidence of coverage aka: the actual policy document for both Humana and Aetna says that when getting treatment by in or, --interesting--also out of network providers, the providers aren't allowed to balance bill.
I assume that if the provider is billing Aetna or Humana the insurance carrier won't pay the bill if the provider is going to balance bill the patient, even if done under the rules of Medicare for providers who choose to balance bill.
Any deep knowledge suggestions here? We can call the billing and claims folks at carrier, mixed results in my experience.
Source of insurance-forums.net
I assume that if the provider is billing Aetna or Humana the insurance carrier won't pay the bill if the provider is going to balance bill the patient, even if done under the rules of Medicare for providers who choose to balance bill.
Any deep knowledge suggestions here? We can call the billing and claims folks at carrier, mixed results in my experience.
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