noncovered

As a participating provider you may only bill the patient and/or the insurance company for covered services provided under the member's health care plan.

When you determine that a service is non-covered by the member's health care plan, you may charge the member your usual and customary fees for such non-covered services, provided you first obtained a signed waiver from the member, specific to that particular service, agreeing in advance to receive and pay for such services. CLICK HERE for the CNC Waiver for Non-Covered Services.

All such waivers must be maintained in the member's health care record. If you fail to obtain a signed waiver from the member, prior to rendering non-covered services, you cannot bill either the patient or the health care plan for those services! Additionally, if you inadvertently bill the health care plan and receive payment for a non-covered service, you must promptly refund any co-payments/deductibles collected from the member in association with those services and you must promptly refund any monies received from the payor.

CNC POLICY:

Participating providers cannot balance bill or collect those monies for non-covered services from the member, UNLESS you obtained an executed, appropriate waiver from the patient for those specific non-covered services prior to rendering the service(s) and such waivers are on file in the member's health care record.

Waivers for non-covered services cannot be generic and must be specific to the actual non-covered service to be rendered to each individual member. This waiver must be maintained in the member's health care record and be readily available for review upon request or an audit. While CNC has provided you with a sample waiver that can be used, you may provide your own waiver but such waivers must include the following information:

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 that the service is not covered by their health care plan
A statement, that 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, parent, or legal guardian, if the patient is a minor

Important Note: Please remember that benefits vary by plan so you may find that a particular service is a covered service under one plan but is a non-covered service under another plan, so please verify benefits prior to rendering any services for each patient!