Re: Regence BCBS Fee Schedule?

[Guest guest]

When you call Regence to check "patient benefits,"they tell you they will pay a certain amount.

Then, when you bill them, they reduce your fee to their "allowed amount." This, in effect, is RAISING the patient's co-pay/out-of-pocket expense (outside the "terms" of their insurance agreement with the patient).

I was not aware that each insurance company can have their own "allowed amount" without disclosing this to the patient or provider offices. (:-)

RR.

[Guest guest]

Yep, that's how it works. Evil, isn't it? So if a patient is

responsible for 30% of your bill (with their Out of Network benefits),

they are responsible for 30% of what you charge, plus what BCBS

chooses not to cover. You can write off the difference, and many

patients seem to expect this courtesy, which is weird to me as I'm not

IN Network with anyone and yet patients seems to think that I somehow

have a contractual obligation to play by the insurance companies rules

(even though it's a contract bt the pt and the insurance company).

So I don't take insurance, bc I'm not good at playing these weird

managed care games. I'm much happier that way:)

Tyna , ND, DC

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

[Guest guest]

Re: “Occasionally we run into problems when a patient receives care and finds out that their ins. company doesn’t cover chiro at all. Now what? Well in this case we usually write off some and reduce the bill,”

An alternative might be to determine our reasonable fees and stand by them, pouring all our energy into great patient acquisition, conversion, service, and wellness education.

More patients are figuring out that insurance is a game and many good doctors and dentists are claiming higher ground.

Much of it depends upon the doctor’s self esteem.

It’s been my biggest struggle in practice and my most rewarding gain.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: ph Medlin <spinetree@...>

Date: Fri, 22 Oct 2010 16:47:22 -0700

< >, Tyna <tyna.moore@...>

Subject: Re: Re: Regence BCBS Fee Schedule?

Well, you could be " in network " and it makes it a LOT easier (no games) and more profitable. No ins. co. wants a patient choosing an out of network provider and they will reimburse accordingly.

But to answer the question of 's: As Tyna pointed out, Out of Network is usually covered as a percentage of doctor's usual and customary rates. The difference is billed to the patient which should not Exceed the Work Comp fee schedule. So, no, you can still bill according to that schedule. The patient picks up the tab. Writing this off wouldn't be an option in our office, as it would have been explained clearly to the patient that they will be responsible for the remaining balance.

My office is in Network for most Ins. companies, but the patient coming in Out of Network should be informed of their 3 choices: 1. Pay us out of pocket rate as we are not contracted with ins. co, thus your bill would be cheaper or 2. Let your ins. company pay it's out of network percentage and you pay the rest, which will undoubtedly be more expensive 3. Access an in-network doctor and pay your co pay.

Occasionally we run into problems when a patient receives care and finds out that their ins. company doesn’t cover chiro at all. Now what? Well in this case we usually write off some and reduce the bill, but they could have saved some money by just knowing their bennies. We've gone through the process of billing etc, and have to charge more.

Then there's the scenario where their coverage is actually paltry, even worse than ASHN etc.., but they in fact have coverage and we are in Network. In this scenario I believe it's illegal for us to reduce the bill to our cash rate because the patient has a contractual agreement with ins. co. and we do as well. Again, if they were aware of how paltry the coverage was, they would not even use the ins. and then we could bill them the out of pocket rate.

Did I say Easier??? Yikes. I think I'm confused now haha. Please correct me or add your 2cents to what I've trudged through here docs!

ph Medlin D.C.

From: Tyna <mailto:tyna.moore@...>

Sent: Thursday, October 21, 2010 3:48 PM

Subject: Re: Regence BCBS Fee Schedule?

Yep, that's how it works. Evil, isn't it? So if a patient is

responsible for 30% of your bill (with their Out of Network benefits),

they are responsible for 30% of what you charge, plus what BCBS

chooses not to cover. You can write off the difference, and many

patients seem to expect this courtesy, which is weird to me as I'm not

IN Network with anyone and yet patients seems to think that I somehow

have a contractual obligation to play by the insurance companies rules

(even though it's a contract bt the pt and the insurance company).

So I don't take insurance, bc I'm not good at playing these weird

managed care games. I'm much happier that way:)

Tyna , ND, DC

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

[Guest guest]

Well, you could be "in network" and it makes it a LOT easier (no games) and more profitable. No ins. co. wants a patient choosing an out of network provider and they will reimburse accordingly.

But to answer the question of 's: As Tyna pointed out, Out of Network is usually covered as a percentage of doctor's usual and customary rates. The difference is billed to the patient which should not Exceed the Work Comp fee schedule. So, no, you can still bill according to that schedule. The patient picks up the tab. Writing this off wouldn't be an option in our office, as it would have been explained clearly to the patient that they will be responsible for the remaining balance.

My office is in Network for most Ins. companies, but the patient coming in Out of Network should be informed of their 3 choices: 1. Pay us out of pocket rate as we are not contracted with ins. co, thus your bill would be cheaper or 2. Let your ins. company pay it's out of network percentage and you pay the rest, which will undoubtedly be more expensive 3. Access an in-network doctor and pay your co pay.

Occasionally we run into problems when a patient receives care and finds out that their ins. company doesn’t cover chiro at all. Now what? Well in this case we usually write off some and reduce the bill, but they could have saved some money by just knowing their bennies. We've gone through the process of billing etc, and have to charge more.

Then there's the scenario where their coverage is actually paltry, even worse than ASHN etc.., but they in fact have coverage and we are in Network. In this scenario I believe it's illegal for us to reduce the bill to our cash rate because the patient has a contractual agreement with ins. co. and we do as well. Again, if they were aware of how paltry the coverage was, they would not even use the ins. and then we could bill them the out of pocket rate.

Did I say Easier??? Yikes. I think I'm confused now haha. Please correct me or add your 2cents to what I've trudged through here docs!

ph Medlin D.C.

From: Tyna

Sent: Thursday, October 21, 2010 3:48 PM

Subject: Re: Regence BCBS Fee Schedule?

Yep, that's how it works. Evil, isn't it? So if a patient is responsible for 30% of your bill (with their Out of Network benefits), they are responsible for 30% of what you charge, plus what BCBS chooses not to cover. You can write off the difference, and many patients seem to expect this courtesy, which is weird to me as I'm not IN Network with anyone and yet patients seems to think that I somehow have a contractual obligation to play by the insurance companies rules (even though it's a contract bt the pt and the insurance company).So I don't take insurance, bc I'm not good at playing these weird managed care games. I'm much happier that way:)Tyna , ND, DCLake Oswego Chiropractic Clinic315 Second StreetLake Oswego, OR 97034503-635-6246Website: http://www.lakeoswegochiro.com

[Guest guest]

We spend a lot of time on the phone to the patient’s

carrier as to exact benefits.

This is written into their folder and if a question arises, we

refer to the phone log for clarification.

This came in handy when a company wanted a refund from us.

I pointed out the info in the phone log and indicated it was a “legal”

document and they

changed their tune and dropped their refund request……

Bob

W. Pfeiffer, DC, DABCO

P. O. Box 606

Pendleton Or 97801

541-276-2550

SCIENCE-BASED MEDICINE ISN'T ALWAYS PRETTY,

BUT IT'S BETTER THAN POLITICS-BASED MEDICINE.

From:

[mailto: ] On Behalf Of ph Medlin

Sent: Friday, October 22, 2010 4:47 PM

; Tyna

Subject: Re: Re: Regence BCBS Fee Schedule?

Well, you

could be " in network " and it makes it a LOT easier (no

games) and more profitable. No ins. co. wants a patient choosing an

out of network provider and they will reimburse accordingly.

But

to answer the question of 's: As Tyna pointed out, Out of Network is

usually covered as a percentage of doctor's usual and customary rates. The

difference is billed to the patient which should not Exceed the Work Comp fee

schedule. So, no, you can still bill according to that schedule. The

patient picks up the tab. Writing this off wouldn't be an option in our

office, as it would have been explained clearly to the patient that they will

be responsible for the remaining balance.

My office

is in Network for most Ins. companies, but the patient coming in Out of

Network should be informed of their 3 choices: 1. Pay us out of pocket rate as

we are not contracted with ins. co, thus your bill would be cheaper or 2. Let

your ins. company pay it's out of network percentage and you pay the rest, which

will undoubtedly be more expensive 3. Access an in-network doctor and pay your

co pay.

Occasionally

we run into problems when a patient receives care and finds out that their ins.

company doesn’t cover chiro at all. Now what? Well in this

case we usually write off some and reduce the bill, but they could have saved

some money by just knowing their bennies. We've gone through the process

of billing etc, and have to charge more.

Then

there's the scenario where their coverage is actually paltry, even worse than

ASHN etc.., but they in fact have coverage and we are in Network. In this

scenario I believe it's illegal for us to reduce the bill to our cash rate

because the patient has a contractual agreement with ins. co. and we do as

well. Again, if they were aware of how paltry the coverage was, they

would not even use the ins. and then we could bill them the out of pocket rate.

Did I say

Easier??? Yikes. I think I'm confused now haha. Please correct me or

add your 2cents to what I've trudged through here docs!

ph

Medlin D.C.

From: Tyna

Sent: Thursday, October

21, 2010 3:48 PM

Subject:

Re: Regence BCBS Fee Schedule?

Yep, that's how it works. Evil, isn't it? So if

a patient is

responsible for 30% of your bill (with their Out of Network benefits),

they are responsible for 30% of what you charge, plus what BCBS

chooses not to cover. You can write off the difference, and many

patients seem to expect this courtesy, which is weird to me as I'm not

IN Network with anyone and yet patients seems to think that I somehow

have a contractual obligation to play by the insurance companies rules

(even though it's a contract bt the pt and the insurance company).

So I don't take insurance, bc I'm not good at playing these weird

managed care games. I'm much happier that way:)

Tyna , ND, DC

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

[Guest guest]

Bob,

very good idea. We also have; and I'm sure most of you do also; a billing software feature that tells you how many times you've 're-billed' per date of service. And a phone log notation section that you can clock start and stop times each time you have to spend staff time with billing issues. All those things go to reasons why an insurance billing collection is more complicated and costly than a TOS patient. (Time of Service). In our last staff meeting, we documented in great detail all the things that raise cost. From staff time to supplies. It was enlightening. I now have a new appreciation for billing costs! And for those of you who are concerned about massage billing in your office, being higher than cash paying clients, I would urge you to document the same thing in your office so you can see if your mark-up is justified.

Minga Guerrero DC

Re: Regence BCBS Fee Schedule?

Yep, that's how it works. Evil, isn't it? So if a patient is

responsible for 30% of your bill (with their Out of Network benefits),

they are responsible for 30% of what you charge, plus what BCBS

chooses not to cover. You can write off the difference, and many

patients seem to expect this courtesy, which is weird to me as I'm not

IN Network with anyone and yet patients seems to think that I somehow

have a contractual obligation to play by the insurance companies rules

(even though it's a contract bt the pt and the insurance company).

So I don't take insurance, bc I'm not good at playing these weird

managed care games. I'm much happier that way:)

Tyna , ND, DC

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

[Guest guest]

Good thread, Bob and Minga. I would add that conversations with insurers are all available as well. "The following conversation may be tape recorded for blah, blah, blah. . ." means it has a reference number. Ask for their reference number at the end of the conversation, which they will provide. Sears, DC, IAYT1218 NW 21st AvePortland, Oregon 97209v: 503-225-0255f: 503-525-6902www.docbones.comOn Nov 23, 2010, at 4:00 PM, AboWoman@... wrote: Bob, very good idea. We also have; and I'm sure most of you do also; a billing software feature that tells you how many times you've 're-billed' per date of service. And a phone log notation section that you can clock start and stop times each time you have to spend staff time with billing issues. All those things go to reasons why an insurance billing collection is more complicated and costly than a TOS patient. (Time of Service). In our last staff meeting, we documented in great detail all the things that raise cost. From staff time to supplies. It was enlightening. I now have a new appreciation for billing costs! And for those of you who are concerned about massage billing in your office, being higher than cash paying clients, I would urge you to document the same thing in your office so you can see if your mark-up is justified. Minga Guerrero DC Re: Regence BCBS Fee Schedule? Yep, that's how it works. Evil, isn't it? So if a patient is responsible for 30% of your bill (with their Out of Network benefits), they are responsible for 30% of what you charge, plus what BCBS chooses not to cover. You can write off the difference, and many patients seem to expect this courtesy, which is weird to me as I'm not IN Network with anyone and yet patients seems to think that I somehow have a contractual obligation to play by the insurance companies rules (even though it's a contract bt the pt and the insurance company). So I don't take insurance, bc I'm not good at playing these weird managed care games. I'm much happier that way:) Tyna , ND, DC Lake Oswego Chiropractic Clinic 315 Second Street Lake Oswego, OR 97034 503-635-6246 Website: http://www.lakeoswegochiro.com