Re: NCBF / Insurance Questions update

[Guest guest]

Thanks for the support - this list serve has made this experience with this

" GUY " (as I am calling him) much easier - the support is invaluable.

Another update: No word from the GUY. I spoke with Regence/BCBS and they

confirmed that I have no obligation to accept anyone into my practice and no

obligation to send a termination letter when there is no relationship. Since I

have liberty to not accept a patient I am not comfortable with, his accusation

of discrimination is not only baseless but he has no way to gain any traction.

I also asked my provider rep about their take on my NCBF and what paperwork

would be necessary. She told me that the NCBF or something like it is getting

very popular in Portland, Oregon and they are aware that many doctors are

charging a NCBF similar to mine. She informed me that they really don't care.

In Jan 2009 there was a change in policy. NCBFs, which would include

experimental treatments for example, or services that don't have a CPTs, used to

be " provider write-offs " and required a waiver of some sort to bill the patient.

After the policy change in Jan 2009 these are now consider these " member

responsibilities " and she says that technically no waiver is necessary in order

to charge a patient for the service. She still recommends a waiver to cover the

physician and to have more transparency with the patient, but it is not required

by the insurance company in order to bill - no ABN required.

When I described my HealthyAccess service of 24 x 7 access to me, she

immediately said, " These are service above and beyond what our contracts require

or most doctors offer. " It was nice to talk to someone who understood the

issues. She didn't see any " cross over " with billable services and didn't

foresee that happening in the future.

It sounds like Regence and maybe other big insurance companies are just not

interested in battling physicians over these services. The change in policy

from " provider write-off " to " member responsibility " has paved the way to make

the whole area a little less cumbersome for both insurance company and

physicians. I wonder if this is some of the last vestiges of managed care

crumbling away. It may be that insurances realize that trying to control

everything the providers can and can't charge the patient for (outside of

covered CPTs) is really just a waste of the insurance company's time - it's

between the patient and physician.

I'm certainly more relieved to know that NCBF has solid footing with regence

patients.

Stew

>

> ,

> I do understand that frustration too - but people have choices.

> Update: So far just a menacing email that he thinks I am discriminating

against him. Checked with my malpractice carrier, BCBS contracts and all my

policies and feel I'm in pretty good stead.

> I do understand the frustration for young healthy people but I also know I'm

underselling a valuable service. I think this situation has convinced me NOT to

raise my rates on the NCBF and to be careful to only persuade but not require

patients to pay for the service. I do have a box for those who are not ready to

pay for service to check " I have questions and am not ready to pay for the

HealthyAccess(NCBF) " . I have 2 or 3 patients who have checked this indefinately

(which doesn't seem fair either).

> Stew

>

> Re: Re: NCBF / Insurance Questions

>

> Stew,

> I agree with all the recommendations listed already - don't take on this

> patient, continue your NCBF, etc.

>

> Just to be the devil's advocate...I can totally see how patients are going

> to get frustrated.

> Due to a combination of lower fees to doctors, higher insurance premiums,

> and docs adding on Non-Covered Benefits Fees, I would also be frustrated to

> have my doc charging me even more.

>

> Here I am...a healthy person who just needs a physical every 2 years - and

> my insurance covers these physicals for " free " - no copay or co-insurance,

> plus my monthly premiums have gone up 15% again this year - for now reason.

> Then the doc wants to charge me a monthly or annual fee for care that I

> likely won't use because I only go to the doctor every 2 years.

> I'd be irritated, too.

>

> On the other hand, if that is how the doctor is running his practice and it

> isn't a good fit for me -- I'd check on using a different doc.

>

> That's the other side that I can see.

> Not saying this patient is right to threaten blackmail - just seeing why he

> might be frustrated with the system.

>

> Hope the situation works out.

>

> Locke, MD

>