We have not received a payment for services rendered to the above-referenced patient..
On 02/21/2013 our office was contacted by a third party carrier (Multiplan) requesting that we sign an agreement to reduce our rate from $43,124.00 to $489.00 stating that the rate was based on the primary surgeons’ reimbursement .Please understand that the primary surgeon has a contract with UHC, therefore to base our rate on a contract agreement between your office and another provider is unacceptable , furthermore after waiting for payment for over 7 months; There is no way that we will accept such reduction.
At this time we are willing to reduce our fees to $30,186.80 and agree not to balance bill your member for the balance of $12,937.20
Please be advised that by the law this right is afforded to me pursuant to Texas law. See:
§ 1301.056. RESTRICTIONS ON PAYMENT AND REIMBURSEMENT.
An insurer or third-party administrator may not reimburse a physician or other practitioner, institutional provider, or organization of physicians and health care providers on a discounted fee basis for covered services that are provided to an insured unless:
(1) The insurer or third-party administrator has contracted with either: (a) The physician or other practitioner, institutional provider, or organization of physicians and health care providers; or (b) A preferred provider organization that has a network of preferred providers and that has contracted with the physician or other practitioner, institutional provider, or organization of physicians and health care providers;
(2) The physician or other practitioner, institutional provider, or organization of physicians and healthcare providers has agreed to the contract and has agreed to provide health care
