Guest guest Posted December 29, 2004 Report Share Posted December 29, 2004 I have recently started accepting and billing Insurance companies. As mentioned by previous folks, insurance does not our fees, in some cases less than 50% of our fees. My question is do you bill the patient for the difference? Example: Your fee is $100. Jane pays you $20, her co-pay. Insurance payment is $50. Remaining balance is $30. Do you bill the patient of the remaining $30? I am debating whether or not to bill insurance company directly versus Superbilling and have the patient pay me and they can file the claim. Any comments, suggestion would be appreciated Regards, Lory Lee L.Ac. Manette Acupuncture & Wellness Center Bremerton WA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2004 Report Share Posted December 29, 2004 It's pretty straight-forward; If you are a contracted provider for the insurance company and/or the provider network it employs, you MAY NOT bill the patient for the remaining balance. If you are NOT a contracted provider for the insurance company and/or the provider network it emplys, you MAY bill the patient for the remaining balance. Giving the superbill to bill themselves after paying you directly is less work for you and can save the patient money. But, you MAY NOT do the superbill approach if you are a contracted provider for that insurance company and/or the provider network it employs. I see you are in the state of Washington, as am I. We can offer a cash discount for payment made the same day as service. If you are not contracted with the insurance company, you can say to the patient (for example): " If you pay me today, you can save $15 (as an example) by taking this superbill and submitting it to your insurer yourself for reimbursement. If you would like ME to bill it for you and not pay for your treatment today, we'll wait for the insurance company to pay and then you will be responsible for anything not paid by them. " How this would look (as an EXAMPLE): Pay today: $100 - $15 for discount for payment same day as service; $85.00 total Practitioner does the billing: $100, insurance pays $70, patient owes the remaining $30; $100 total Again, this is just an example and does not reflect anyone's fees in particular. I hope it helps. _____ Lory Lee M.S.O.M, L.Ac., NADA [lory] Wednesday, December 29, 2004 7:55 AM Chinese Medicine Insurance Billing Question I have recently started accepting and billing Insurance companies. As mentioned by previous folks, insurance does not our fees, in some cases less than 50% of our fees. My question is do you bill the patient for the difference? Example: Your fee is $100. Jane pays you $20, her co-pay. Insurance payment is $50. Remaining balance is $30. Do you bill the patient of the remaining $30? I am debating whether or not to bill insurance company directly versus Superbilling and have the patient pay me and they can file the claim. Any comments, suggestion would be appreciated Regards, Lory Lee L.Ac. Manette Acupuncture & Wellness Center Bremerton WA http://babel.altavista.com/ and adjust accordingly. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 30, 2004 Report Share Posted December 30, 2004 I believe you can NOT bill the patient that $30 difference. The ins. cos. will get angry. You must " eat " the difference. John Garbarni --- " Lory Lee M.S.O.M, L.Ac., NADA " <lory wrote: > > I have recently started accepting and billing > Insurance companies. As > mentioned by previous folks, insurance does not our > fees, in some cases less > than 50% of our fees. My question is do you bill the > patient for the > difference? > > Example: Your fee is $100. Jane pays you $20, her > co-pay. Insurance payment > is $50. Remaining balance is $30. Do you bill the > patient of the remaining > $30? > > I am debating whether or not to bill insurance > company directly versus > Superbilling and have the patient pay me and they > can file the claim. > > Any comments, suggestion would be appreciated > > Regards, > Lory Lee L.Ac. > Manette Acupuncture & Wellness Center > Bremerton WA > > > All your favorites on one personal page – Try My Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2004 Report Share Posted December 31, 2004 If you signed up with the insurance company to be a preferred provider you cannot bill for the difference. Othewise you can. Laura Chinese Medicine , John Garbarini <johnlg_2000> wrote: > > I believe you can NOT bill the patient that $30 > difference. The ins. cos. will get angry. You must > " eat " the difference. John Garbarni > --- " Lory Lee M.S.O.M, L.Ac., NADA " > <lory@m...> wrote: > > > > > I have recently started accepting and billing > > Insurance companies. As > > mentioned by previous folks, insurance does not our > > fees, in some cases less > > than 50% of our fees. My question is do you bill the > > patient for the > > difference? > > > > Example: Your fee is $100. Jane pays you $20, her > > co-pay. Insurance payment > > is $50. Remaining balance is $30. Do you bill the > > patient of the remaining > > $30? > > > > I am debating whether or not to bill insurance > > company directly versus > > Superbilling and have the patient pay me and they > > can file the claim. > > > > Any comments, suggestion would be appreciated > > > > Regards, > > Lory Lee L.Ac. > > Manette Acupuncture & Wellness Center > > Bremerton WA > > > > > > > > > > > > > All your favorites on one personal page – Try My > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2004 Report Share Posted December 31, 2004 I would provide the patient with a HCFA bill to submit to the insurance company and have them pay you at the time of visit. Otherwise you waste too much time trying to collect from them, and this approach puts the responsibility on the patient, where it belongs. Always bill your full fee unless you have a specific contract with the insurer which limits your charges. Avery L. Jenkins, DC, DACBN, FIAMA Chiropractic Physician Diplomate, American Clinical Board of Nutrition Fellow, International Academy of Medical Acupuncture Kent, CT www.docaltmed.com " Life expands and contracts in proportion to one's courage. " -- Anais Nin - " Lory Lee M.S.O.M, L.Ac., NADA " <lory <Chinese Medicine > Wednesday, December 29, 2004 10:54 AM Insurance Billing Question > > > I have recently started accepting and billing Insurance companies. As > mentioned by previous folks, insurance does not our fees, in some cases > less > than 50% of our fees. My question is do you bill the patient for the > difference? > > Example: Your fee is $100. Jane pays you $20, her co-pay. Insurance > payment > is $50. Remaining balance is $30. Do you bill the patient of the remaining > $30? > > I am debating whether or not to bill insurance company directly versus > Superbilling and have the patient pay me and they can file the claim. > > Any comments, suggestion would be appreciated > > Regards, > Lory Lee L.Ac. > Manette Acupuncture & Wellness Center > Bremerton WA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2004 Report Share Posted December 31, 2004 Not only is that incorrect, it is illegal. It would mean that, without a contract with the insurance company which requires reduced fees, you have what is called a " dual fee schedule " in which one class of patients is billed one amount, and another class of patients is billed a second amount. Avery L. Jenkins, DC, DACBN, FIAMA Chiropractic Physician Diplomate, American Clinical Board of Nutrition Fellow, International Academy of Medical Acupuncture Kent, CT www.docaltmed.com " Life expands and contracts in proportion to one's courage. " -- Anais Nin - " John Garbarini " <johnlg_2000 <Chinese Medicine > Thursday, December 30, 2004 10:31 AM Re: Insurance Billing Question > > > I believe you can NOT bill the patient that $30 > difference. The ins. cos. will get angry. You must > " eat " the difference. John Garbarni > --- " Lory Lee M.S.O.M, L.Ac., NADA " > <lory wrote: > >> >> I have recently started accepting and billing >> Insurance companies. As >> mentioned by previous folks, insurance does not our >> fees, in some cases less >> than 50% of our fees. My question is do you bill the >> patient for the >> difference? >> >> Example: Your fee is $100. Jane pays you $20, her >> co-pay. Insurance payment >> is $50. Remaining balance is $30. Do you bill the >> patient of the remaining >> $30? >> >> I am debating whether or not to bill insurance >> company directly versus >> Superbilling and have the patient pay me and they >> can file the claim. >> >> Any comments, suggestion would be appreciated >> >> Regards, >> Lory Lee L.Ac. >> Manette Acupuncture & Wellness Center >> Bremerton WA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2004 Report Share Posted December 31, 2004 There is a great course I took several years ago that taught me the ins and outs of insurance. The course is offered thru HJ Ross. He's located in Southern California but I believe he gives the seminar in different regions. It's well worth the cost... http://www.hjrosscompany.com/new/ Brian " Dr. Avery L. Jenkins " <ajenkins wrote: Not only is that incorrect, it is illegal. It would mean that, without a contract with the insurance company which requires reduced fees, you have what is called a " dual fee schedule " in which one class of patients is billed one amount, and another class of patients is billed a second amount. Avery L. Jenkins, DC, DACBN, FIAMA Chiropractic Physician Diplomate, American Clinical Board of Nutrition Fellow, International Academy of Medical Acupuncture Kent, CT www.docaltmed.com " Life expands and contracts in proportion to one's courage. " -- Anais Nin - " John Garbarini " <johnlg_2000 <Chinese Medicine > Thursday, December 30, 2004 10:31 AM Re: Insurance Billing Question > > > I believe you can NOT bill the patient that $30 > difference. The ins. cos. will get angry. You must > " eat " the difference. John Garbarni > --- " Lory Lee M.S.O.M, L.Ac., NADA " > <lory wrote: > >> >> I have recently started accepting and billing >> Insurance companies. As >> mentioned by previous folks, insurance does not our >> fees, in some cases less >> than 50% of our fees. My question is do you bill the >> patient for the >> difference? >> >> Example: Your fee is $100. Jane pays you $20, her >> co-pay. Insurance payment >> is $50. Remaining balance is $30. Do you bill the >> patient of the remaining >> $30? >> >> I am debating whether or not to bill insurance >> company directly versus >> Superbilling and have the patient pay me and they >> can file the claim. >> >> Any comments, suggestion would be appreciated >> >> Regards, >> Lory Lee L.Ac. >> Manette Acupuncture & Wellness Center >> Bremerton WA http://babel.altavista.com/ and adjust accordingly. If you are a TCM academic and wish to discuss TCM with other academics, click on this link Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 31, 2004 Report Share Posted December 31, 2004 If you are not contracted as a provider with insurance than you can bill the patient the remainder up to your fee level, if you are contracted then you cannot. I opt for the superbill idea for many reasons. First is that you might not be busy enough to afford to hire someone to call to get paid reduced fees. Second is that you will most likely get a reduced fee. Third is that it takes a lot of phone time to wait to get paid, your bills will not wait. Fourth, you will get more of the fee you feel you deserve. Lastly, you will have fewer emotional problems and sleep better due to lower stress levels related to not enough money. Hope this helps. Later Mike W. Bowser, L Ac On 12/31/04 8:36 AM, " Dr. Avery L. Jenkins " <ajenkins wrote: > > Not only is that incorrect, it is illegal. It would mean that, without a > contract with the insurance company which requires reduced fees, you have > what is called a " dual fee schedule " in which one class of patients is > billed one amount, and another class of patients is billed a second amount. > > Avery L. Jenkins, DC, DACBN, FIAMA > Chiropractic Physician > Diplomate, American Clinical Board of Nutrition > Fellow, International Academy of Medical Acupuncture > Kent, CT > www.docaltmed.com > > > " Life expands and contracts in proportion to one's courage. " -- Anais Nin > - > " John Garbarini " <johnlg_2000 > <Chinese Medicine > > Thursday, December 30, 2004 10:31 AM > Re: Insurance Billing Question > > >> > >> > >> > I believe you can NOT bill the patient that $30 >> > difference. The ins. cos. will get angry. You must >> > " eat " the difference. John Garbarni >> > --- " Lory Lee M.S.O.M, L.Ac., NADA " >> > <lory wrote: >> > >>> >> >>> >> I have recently started accepting and billing >>> >> Insurance companies. As >>> >> mentioned by previous folks, insurance does not our >>> >> fees, in some cases less >>> >> than 50% of our fees. My question is do you bill the >>> >> patient for the >>> >> difference? >>> >> >>> >> Example: Your fee is $100. Jane pays you $20, her >>> >> co-pay. Insurance payment >>> >> is $50. Remaining balance is $30. Do you bill the >>> >> patient of the remaining >>> >> $30? >>> >> >>> >> I am debating whether or not to bill insurance >>> >> company directly versus >>> >> Superbilling and have the patient pay me and they >>> >> can file the claim. >>> >> >>> >> Any comments, suggestion would be appreciated >>> >> >>> >> Regards, >>> >> Lory Lee L.Ac. >>> >> Manette Acupuncture & Wellness Center >>> >> Bremerton WA Quote Link to comment Share on other sites More sharing options...
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