Insurance Billing Question--to Mike and all

[Guest guest]

Hi Mike,

 

So are you saying that you have not contracted with insurance agencies

at all? Do you find that most insurance companies are willing to pay

for an out of network practitioner, or are there quite a few that turn

you down?

 

Also, when using a super bill do you use the same HCFA form, or is

there another form? If so, do you know where I can get it?

 

Thanks,

 

Laura

 

 

Chinese Medicine , mike Bowser

<naturaldoc1@h...> wrote:

>

> 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@c...> 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@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

[Guest guest]

Sat, 01 Jan 2005 00:37:03 -0000, " heylaurag " <heylaurag wrote:

 

>Do you find that most insurance companies are willing to pay for an out of

network practitioner, or are there quite a few that turn you down?

 

Insurance is contractual. The benefits/exclusions (usually in a booklet

which should be given to every covered patient) will specify if and what

(amount or percentage) is paid for in-network and out-of-network

procedures. It's not a matter, in theory, of what they are " willing " to pay.

 

" In theory " because they often interpret situations in unexpected ways, and

challenge or deny claims in a multitude of ways - partially by simply human

error or oversight, partially, it is widely suspected, by operational

policies intended to delay or avoid altogether giving out money.

 

Sometimes this can work both ways. Once in my experience, an adjuster was

having a good day, and denied payment for an acupuncture treatment because

the coverage's' annual number of ATx treatments was already exceeded, but

then threw in a payment for an accompanying herbal supplement (a 99070),

which really wasn't covered at all!