We Only Pay For 'X' Amount of Fractions. But You Want More...

Let's say Evicore through prior auth and peer to peer will only pay for 28 fractions. However, you don't want to do that for your patient and instead treat with 40 fractions. You bill the insurance company for 28 fractions; however, of course your own in house medical records would show 40 treatments. The example is a prostate case. Is doing more treatments, but not billing for them, against any known guidelines or laws, regarding any payor? Examples would be nice. This seems to be a big... Read more
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Radiation Oncology Source Type: forums