Most medical services and treatments provided by physicians, clinics, and hospitals are often covered by health insurance companies, public health institutions, and other payer groups. Most prescription medications, wellness care, and even patient-use medical equipment fall under this category. However, many medical billing firms are aware that private payers and government agencies do not always cover specific treatments, goods, medications, and services. These are called non-covered services which require the patient to pay out of their pocket. If you are confused, here is a guide to understanding non-covered services in medical billing!
Like its name, non-covered medical services are services that are not covered by the government or private payers. There are many medical services offered by medical providers but there are some non-covered medical services you should be aware of. This includes, but is not limited to:
To be recognized as a claim, the services should meet the particular medical requirements as stated in the statute, manuals, and regulations outlined by the National Coverage Determinations and Local Coverage Determinations. If they do meet these requirements, the attending physician must specify the exact symptom, sign, or patient complaint that makes the service necessary and reasonable.
To qualify as medically necessary and reasonable, the items and services must be proven effective and safe. The following criteria are used in this process:
Usually, a physician or other medical professional can bill the patient for non-covered services. Before performing the diagnosis, treatment, or service, the physician should inform the patient so that they are aware that they are liable for the payment as an out-of-pocket charge. You can also check the payer’s website for coverage information on that particular service.
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