Question: Case Study: Dr. Maxwell Stark is a PAR provider with Blue Cross and Blue Shield; Dr. Forrest Wilson is nonPAR with the same insurer. Both
Case Study: Dr. Maxwell Stark is a PAR provider with Blue Cross and Blue Shield; Dr. Forrest Wilson is nonPAR with the same insurer. Both providers are specialists in gastroenterology. Both physicians charge $1000 for a colonoscopy. Blue Cross and Blue Shield allows $700 as its UCR fee for this procedure. Assuming each provider has a patient who undergoes a colonoscopy, each patient has satisfied his or her yearly deductible, and each has paid the same amount of coinsurance (20% of the "allowable" charge--$140), how much can Dr. Stark bill his colonoscopy patient? How much can Dr. Wilson bill his patient?
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