Question

Which must accept whatever a payer reimburses for procedures or services performed?

Answer 1

Answer: The participating provider must accept whatever the payer will reimburse for the services or procedures that were performed.

Explanation:

The participating provider already has an agreement in place with the insurance company prior to any services rendered. They will have price list for the insurance company and they will negotiate a pay and must accept the payment, based on the prior agreement. The patient will not have to pay the difference between the price submitted to the insurance company and what is actually paid.

If a person uses a non-participating provider, then they will be responsible for any costs incurred that the insurance does not cover. This is why it is very important to make sure that your specific insurance is taken by the doctor or surgeon seeing you at the time.