Should non-covered services be billed?

HNS Policy

With few exceptions, non-covered services cannot be billed to HNS contracted payors.

Exception: When you need to report a non-covered service in order to obtain a denial for coordination of benefits and/or if your patient needs to obtain a denial for reimbursement under a flexible spending account or HSA/HRA account, the service(s) can be reported to a payor that does not cover the service(s), provided:

1. The patient’s health care record includes evidence to support the need to bill the non-covered service to the payor.
   
   
2. The patient's health care record includes a signed and dated waiver for the specific non-covered service and the fee for that service.

HNS providers must verify benefits, prior to providing services, to determine if the services planned are covered chiropractic benefits under a patient’s health care plan. 

Some payor corporate medical policies identify non-covered services.  HNS providers must comply with any applicable payor corporate medical policies.

Please remember that information received when verifying benefits does not supersede information published in the payor's corporate medical policies.

Waivers for Non-Covered Services 

Prior to rendering any non-covered service, HNS providers must first obtain an executed, appropriate waiver from the patient. This waiver cannot be a generic waiver but must be specific to the actual procedure or service to be rendered to each individual member.  All waivers must be maintained in the patient’s health care record. 

Click here for HNS' "Non-Covered Services Waiver".  This form is also available in Microsoft Word format on this website under "HNS Forms".

Waivers must include:

• Practice and/or Provider’s name.
  
  
• Patient’s name.
  
  
• Date waiver obtained.
  
  
• The specific service the provider recommends.
  
  
• The cost of the service.
  
  
• A statement indicating the service is not covered by their health care plan.
  
  
• A statement that indicates, by signing such a waiver, the member agrees to the service or procedure and also agrees to pay for the service or procedure.
  
  
• The signature of the adult patient, or parent or legal guardian if the patient is a minor.

HNS providers cannot bill the patient for non-covered services provided unless they have first obtained the appropriate signed waiver and the waiver is on file in the patient’s health care record.

Providers who fail to obtain a signed waiver from the member prior to the rendering of a non-covered service, cannot bill the patient for those services.

Additionally, providers will be required to refund any monies collected from the patient for any non-covered services provided for which a signed waiver was not first obtained. So please remember to obtain a signed waiver and be sure that it is maintained in the patient’s health care record.

NOTE:The signing of a "waiver" does not allow a provider to "balance bill" a patient for covered services provided.