3rd part reimbursement & TCM

[Guest guest]

I have recently been offered the opportunity to provide TCM to a very

large private insurer. Neither the insurer nor myself have experience

with this arrangement. In my practice I usually charge for each visit

as an office visit and the patients pay for their herbs. This is ok

with the insurer as they will reimburse for 80% of each office visit

and their rs will pay the remaining plus cost of herbs. Can

anyone offer some experience in this area?

[Guest guest]

You may want to make sure there is no " cap " on the amount they will pay on

an office visit or else you will only get back 80% of what they feel is a

valid charge for acupuncture,which may be quite different than your fee.

Also, insurance companies that I have dealt with seem to lose claims, not

receive one's that were sent, and be located in China for the time it takes

to get paid by them. They usually get reimbursement back much quicker to the

insured than to the doctor, which is why (after 12 years of accepting

insurance and billing) we're stopping as of January. The insurer your

dealing with may be better than some. Who is it, if I may ask? I may be able

to give feedback. Best to you, Shelly Krahn, L.Ac(San Diego)

 

 

> " Aris Skaliotis " <askaliotis

>

>

> 3rd part reimbursement & TCM

>Sun, 22 Oct 2000 19:53:13 -0000

>

>I have recently been offered the opportunity to provide TCM to a very

>large private insurer. Neither the insurer nor myself have experience

>with this arrangement. In my practice I usually charge for each visit

>as an office visit and the patients pay for their herbs. This is ok

>with the insurer as they will reimburse for 80% of each office visit

>and their rs will pay the remaining plus cost of herbs. Can

>anyone offer some experience in this area?

>

 

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