Re: patients submitting their own to insurance

[Guest guest]

This case, pt PAYS FIRST and then THEY get their money.

Provide them a receipt for their payment.

NO discount UNLESS THEY PAY "SAME DAY DISCOUNT" means SAME DAY.

NOT "buy the milk and pay 90 days later."

My opinion, yours?

Matt in Western PA

FP since 1988

Solo since 2004

PS: as more of the docs in Maine (? 70%) are employed, has a much higher problem than I do....

MWL

patients submitting their own to insurance

Hi I have only a few people take me up on the discount, then submit themsleves thing I am hearing from a woman who just brought her kids in that she now needs a HCFA 1500 filled out So she emails and says what is that so I tell her , now she wants my signature onit! IF I have to provide servcies it wipes out her discounts... I hear form you folks all the time that maybe e some thing was not in the right box etc not a clean claim(vomit) so I would not sign it til I c cleared it with my biller who could ok it.. but really is this no the latest trick from insurxnce that my bill with cpt/.icdm/tax id cannot be used?? ADvice?-- MD ph fax

[Guest guest]

I would do it once, but explain to the patient that if her insurance company requires filing a CMS-1500, then that is the same as you having to file a claim and that in the future you would not be able to offer the discount because you offer the discount so that you don't have to do the 1500.Having just helped my mom file out of network claims with her instance company (Guardian), I can tell you that they required a copy of a super bill with the diagnosis and CPT codes and a copy of her paid receipt. No MD signature, tho.

Hi I have only a few people take me up on the discount, then submit themsleves thing I am hearing from a woman who just brought her kids in that she now needs a HCFA 1500 filled out So she emails and says what is that so I tell her , now she wants my signature onit! IF I have to provide servcies it wipes out her discounts... I

hear form you folks all the time that maybe e some thing was not in the right box etc not a clean claim(vomit) so I would not sign it til I c cleared it with my biller who could ok it.. but really is this no the latest trick from insurxnce that my bill with cpt/.icdm/tax id cannot be used?? ADvice?

-- MD ph fax

[Guest guest]

thanks Matt I am not sure  we are on the same page - I have been paidPatient  got a perfectly good receipt.I am thinking this is a barrier insurance set sup To get their money or even applied to  deductible the patietn asks fo r help submitting

I never see hcfa and am reluctant to sign  things I cannot verify to the validy of.,( box 17 box  27 whatever, decimal points ...you know?- if involve the biller I would have to pay her so then  charge the patietnI told the patient to call and wrangle with them and to talk to the State bureau of  insuracne  consumer division

ly last year  I used some health care dollars and  Blue Cross -my own-  kept telling me I could not  pay then submit   I only wanted it to go towards teh 5,000 deductible   I tried and they said oh wrong format  and   after a while gave up

I iwll use what I learn from you guys and  pass onto het patient though of course none of you are in MAine The firm is Harvard PIlgrim who are real knuckleheads having let me accredit with them and be a provider then throw me out 1 yr later becasue I would not  join some network where I had to  take all insuracne comers( and it actually hasn't matter much in terms of patients staying or how much who gets paid ).

 

I would do it once, but explain to the patient that if her insurance company requires filing a CMS-1500, then that is the same as you having to file a claim and that in the future you would not be able to offer the discount because you offer the discount so that you don't have to do the 1500.

Having just helped my mom file out of network claims with her instance company (Guardian), I can tell you that they required a copy of a super bill with the diagnosis and CPT codes and a copy of her paid receipt. No MD signature, tho. 

 

Hi I have only a  few people take me up on the  discount, then submit themsleves thing  I am hearing from a woman  who just brought  her kids in that she now needs a   HCFA 1500 filled out  So she emails and  says what is that so I tell her , now she wants my signature  onit!  IF I have to provide servcies it wipes out her discounts... I

 hear form you folks all the time that maybe e some thing was not in the right box  etc   not a clean claim(vomit) so I would not sign it til I c cleared it with my biller who could ok it.. but really is this no the latest trick from insurxnce  that my   bill with  cpt/.icdm/tax id  cannot be used?? ADvice?

--      MD          ph    fax

--      MD          ph    fax

[Guest guest]

Our EMR, AC allows us to provide a 1500 almost the moment the note is signed, INCLUDING, on that form, how much they paid and what their patient balance is to US.... We even include their Check # on it. This makes sure that the problem from then on is theirs and only theirs.... If we don't PAR then we don't want to know about it and they know that walking in.... We have Drop Aetna, CIGNA, UHC, MVP for various but all too similar reasons and I am always MORE than willing to explain the basic particulars of why and how that came about.... The patients eyes glaze over and soon enough they understand why we had to leave their "Wonderful" carrier of "Choice" (Obviously their Employer's Choice that is....).

Not PAR, means just that, Not PAR.... Here is the first CMS 1500, after that, it's between you and your carrier and we don't want to know about it.... BTW, our prices after over 5 years of not adjusting almost any codes except those that came back paid in full (IE, we're not charging enough) are now so close to what the majors are paying, we do NOT offer any discount to cash patients because both sides are paying almost the same give or take $5-$10 bucks on the main level 3 and 4 E & M coded office visits. It keeps us safe with the gov't, the carriers and almost level with everyone, even the cash pays.

And again I let our patients know that we have a very sane and fair set of charges that allows us to stay one step on the "Right Side" of the law, not some twice what any carrier is ever going to pay set of Fake Charges that leaves the self pays paying super charges... It's fair, it's safe and legal and it allows us to honestly Explain the Stupidity of the game and how well thought out for us and the Patients our charges and policies, choices really are.... We did not create this insane system, we are simply attempting to run a business that is supposed to feed our family pay our debts and bills, while providing a level of personal care that leaves the majority of the other practices in the dust.... That should capture most of the honest good natured people and those that it bothers are the problem patients that are expecting us to Unfairly take it on the Chin for THEM while we get bullied and pushed

around by the powers that be... And to us that is a problem selfish, non-IMP like and appreciating patient that is all too free to leave or not even establish... They want something for nothing and that buys then any one of the numerous Meat Markets down the street and across town....

It's not easy, it is salesmanship on a one on one, person to person level.... One patient or family at a time... But by the time we get thru either we have won a great trusted ally and appreciative customer patient or we have weeded out the ones who just want someone else to be bothered to fix it and be able to turn a selfish, disinterested blind eye to the entire thing and expect anyone and everyone else to solve what is in reality everyone including theirs, ours too, problems.

To: Sent: Sunday, July 24, 2011 10:37 AMSubject: Re: patients submitting their own to insurance

This case, pt PAYS FIRST and then THEY get their money.

Provide them a receipt for their payment.

NO discount UNLESS THEY PAY "SAME DAY DISCOUNT" means SAME DAY.

NOT "buy the milk and pay 90 days later."

My opinion, yours?

Matt in Western PA

FP since 1988

Solo since 2004

PS: as more of the docs in Maine (? 70%) are employed, has a much higher problem than I do....

MWL

patients submitting their own to insurance

Hi I have only a few people take me up on the discount, then submit themsleves thing I am hearing from a woman who just brought her kids in that she now needs a HCFA 1500 filled out So she emails and says what is that so I tell her , now she wants my signature onit! IF I have to provide servcies it wipes out her discounts... I hear form you folks all the time that maybe e some thing was not in the right box etc not a clean claim(vomit) so I would not sign it til I c cleared it with my biller who could ok it.. but really is this no the latest trick from insurxnce that my bill with cpt/.icdm/tax id cannot be used?? ADvice?-- MD ph fax 207 778

3544

[Guest guest]

RE applied to deductible.

Yes, of course then you need to submit; once I've submitted and statement comes back applied to deductible, I will often "offer" to give 10% discount on THAT just to get something in the door but when that bill comes around ONLY offer 10% off THAT amount if "prompt pay" from pt....

There are exceptions to all rules.

Matt

Re: patients submitting their own to insurance

thanks Matt I am not sure we are on the same page - I have been paidPatient got a perfectly good receipt.I am thinking this is a barrier insurance set sup To get their money or even applied to deductible the patietn asks fo r help submitting I never see hcfa and am reluctant to sign things I cannot verify to the validy of.,( box 17 box 27 whatever, decimal points ...you know?- if involve the biller I would have to pay her so then charge the patietnI told the patient to call and wrangle with them and to talk to the State bureau of insuracne consumer divisionly last year I used some health care dollars and Blue Cross -my own- kept telling me I could not pay then submit I only wanted it to go towards teh 5,000 deductible I tried and they said oh wrong format and after a while gave upI iwll use what I learn from you guys and pass onto het patient though of course none of you are in MAine The firm is Harvard PIlgrim who are real knuckleheads having let me accredit with them and be a provider then throw me out 1 yr later becasue I would not join some network where I had to take all insuracne comers( and it actually hasn't matter much in terms of patients staying or how much who gets paid ).

I would do it once, but explain to the patient that if her insurance company requires filing a CMS-1500, then that is the same as you having to file a claim and that in the future you would not be able to offer the discount because you offer the discount so that you don't have to do the 1500.

Having just helped my mom file out of network claims with her instance company (Guardian), I can tell you that they required a copy of a super bill with the diagnosis and CPT codes and a copy of her paid receipt. No MD signature, tho.

Hi I have only a few people take me up on the discount, then submit themsleves thing I am hearing from a woman who just brought her kids in that she now needs a HCFA 1500 filled out So she emails and says what is that so I tell her , now she wants my signature onit! IF I have to provide servcies it wipes out her discounts... I hear form you folks all the time that maybe e some thing was not in the right box etc not a clean claim(vomit) so I would not sign it til I c cleared it with my biller who could ok it.. but really is this no the latest trick from insurxnce that my bill with cpt/.icdm/tax id cannot be used?? ADvice?-- MD ph fax

-- MD ph fax

[Guest guest]

Still wasting time and money processing their insurance.... Not the same as here it is, now it's up to you to deal with their "Barriers" to paying for care.... As said here, these kinds of things are nothing more than intentionally created barriers to payment for decent and honest care already provided for. And getting away with NOT paying for it, and making it more difficult to get a "Clean Claim" thru and then it requires more and more hand processing and re-processing, doctor and staff involvement is the exact reason to NOT PAR and to pass this PIA back to the patients...

As painful as it is to the patients to have to deal with a few times a year, it is super insane to require and pass this insanity and all too intentionally errected barriers back to us for each and every visit and service we provide..... I do honestly believe that the passing of this insanity back upon the patients in MASS Amounts to make them squirm and get upset enough by it, and have it come out of their pockets too, where it hurts, is the only way to pressure the powers that be to finally get rid of their well paying supporters from the insurance industry or at least finally create real insurance reforms that inlcude us and our concerns by making them the entire American public's concerns.... As long as we keep eating the difference and insulating our patients from the actual PAIN that the present system inflicts upon us each and every day, there will never be enough of an honest and well founded

outcry for change.... We get screwed in silence behind closed doors, what does the patient know or care???? Right? But please pay here and now, and now YOU go deal with you insurance carrier and their Insane Barriers created only to make it that much harder to do their job, Covering and Paying for Honest and Needed, Already provided for healthcare, only then will there be enough of a Mass Outcy to do something to assist us in freeing us and therefore the patients too from our mutual bondage to these greedy starve us all out Master...

Pay in full at time of service, means just that..... I washed my hands of your carrier for various very sound reasons and at extreme financial and social pressure and risk, it is never a choice made easily and capriciously..... I'm really sorry but this is now your fight to wage and better you have to wage it only a half a dozen times a year or so, as opposed to us having to wage such fights over a dozen times a day.... You can take the time to slowly walk your few claims thru and babysit them properly to make sure that they get paid as they should.... But when we have to do them enmass, production line style and suffer the losses in reduced payments and lost financial resources because we have to spend time and money fighting for YOUR healthcare to be properly paid for.... something always get lost in the wash....

Did we provide good if not exceptional care for you today???? Are you happy with the services you got and the doctor who provided them??? Do you feel our charges are reasonable and in line with the present Cost of Living and other market forces??? Do you not respect and care about us, your doctor and the financial viability of this practice so you can continue to recieve this good level of personal care???? Are we NOT worth a little extra effort or cost to access this higher, better, more personal level of care???

Then Please, take back some personal level of involvement and potentially risk of the cost as well to help keep this pratice and this manner of care viable and alive. I have to wash my hands of it for our and your best interests and the best and collective interests of each and every patient who comes here looking for and expecting the same....

To: Sent: Sunday, July 24, 2011 12:34 PMSubject: Re: patients submitting their own to insurance

RE applied to deductible.

Yes, of course then you need to submit; once I've submitted and statement comes back applied to deductible, I will often "offer" to give 10% discount on THAT just to get something in the door but when that bill comes around ONLY offer 10% off THAT amount if "prompt pay" from pt....

There are exceptions to all rules.

Matt

Re: patients submitting their own to insurance

thanks Matt I am not sure we are on the same page - I have been paidPatient got a perfectly good receipt.I am thinking this is a barrier insurance set sup To get their money or even applied to deductible the patietn asks fo r help submitting I never see hcfa and am reluctant to sign things I cannot verify to the validy of.,( box 17 box 27 whatever, decimal points ...you know?- if involve the biller I would have to pay her so then charge the patietnI told the patient to call and wrangle with them and to talk to the State bureau of insuracne consumer divisionly last year I used some health care dollars and Blue Cross -my own- kept telling me I could not pay then submit I only wanted it to go towards teh 5,000 deductible I tried and they said oh wrong format and after a while gave upI

iwll use what I learn from you guys and pass onto het patient though of course none of you are in MAine The firm is Harvard PIlgrim who are real knuckleheads having let me accredit with them and be a provider then throw me out 1 yr later becasue I would not join some network where I had to take all insuracne comers( and it actually hasn't matter much in terms of patients staying or how much who gets paid ).

I would do it once, but explain to the patient that if her insurance company requires filing a CMS-1500, then that is the same as you having to file a claim and that in the future you would not be able to offer the discount because you offer the discount so that you don't have to do the 1500.

Having just helped my mom file out of network claims with her instance company (Guardian), I can tell you that they required a copy of a super bill with the diagnosis and CPT codes and a copy of her paid receipt. No MD signature, tho.

Hi I have only a few people take me up on the discount, then submit themsleves thing I am hearing from a woman who just brought her kids in that she now needs a HCFA 1500 filled out So she emails and says what is that so I tell her , now she wants my signature onit! IF I have to provide servcies it wipes out her discounts... I hear form you folks all the time that maybe e some thing was not in the right box etc not a clean claim(vomit) so I would not sign it til I c cleared it with my biller who could ok it.. but really is this no the latest trick from insurxnce that my bill with cpt/.icdm/tax id cannot be used?? ADvice?-- MD ph 207 778

3313 fax

-- MD ph fax

[Guest guest]

Jean- your EHR does not spit out a CMS 1500 form? I use OfficeAlly and I plug in DX, CPT code, then put in fee paid and the EHR fills all the rest with everything in the right place. You can send a pft to pt or forwrd to insurnce for them and have check sent to pt - there is a check box for this. I even now know how to do secondary claims electronically too. OA help desk taught me

 

thanks Matt I am not sure  we are on the same page - I have been paidPatient  got a perfectly good receipt.I am thinking this is a barrier insurance set sup To get their money or even applied to  deductible the patietn asks fo r help submitting

I never see hcfa and am reluctant to sign  things I cannot verify to the validy of.,( box 17 box  27 whatever, decimal points ...you know?- if involve the biller I would have to pay her so then  charge the patietnI told the patient to call and wrangle with them and to talk to the State bureau of  insuracne  consumer division

ly last year  I used some health care dollars and  Blue Cross -my own-  kept telling me I could not  pay then submit   I only wanted it to go towards teh 5,000 deductible   I tried and they said oh wrong format  and   after a while gave up

I iwll use what I learn from you guys and  pass onto het patient though of course none of you are in MAine The firm is Harvard PIlgrim who are real knuckleheads having let me accredit with them and be a provider then throw me out 1 yr later becasue I would not  join some network where I had to  take all insuracne comers( and it actually hasn't matter much in terms of patients staying or how much who gets paid ).

 

I would do it once, but explain to the patient that if her insurance company requires filing a CMS-1500, then that is the same as you having to file a claim and that in the future you would not be able to offer the discount because you offer the discount so that you don't have to do the 1500.

Having just helped my mom file out of network claims with her instance company (Guardian), I can tell you that they required a copy of a super bill with the diagnosis and CPT codes and a copy of her paid receipt. No MD signature, tho. 

 

Hi I have only a  few people take me up on the  discount, then submit themsleves thing  I am hearing from a woman  who just brought  her kids in that she now needs a   HCFA 1500 filled out  So she emails and  says what is that so I tell her , now she wants my signature  onit!  IF I have to provide servcies it wipes out her discounts... I

 hear form you folks all the time that maybe e some thing was not in the right box  etc   not a clean claim(vomit) so I would not sign it til I c cleared it with my biller who could ok it.. but really is this no the latest trick from insurxnce  that my   bill with  cpt/.icdm/tax id  cannot be used?? ADvice?

--      MD          ph    fax

--      MD          ph    fax

-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above.

 If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.

[Guest guest]

Thanks everyone Elaine no  no 1500  I  use a biller I I am moslty Medicare some mediciad and also alot of BlueCross a few  others So  no need  for hcfaI have a fabulous biller I thought about office ally but itis really helpful to have a real person to help me for  my sitauioan

 

Jean- your EHR does not spit out a CMS 1500 form? I use OfficeAlly and I plug in DX, CPT code, then put in fee paid and the EHR fills all the rest with everything in the right place. You can send a pft to pt or forwrd to insurnce for them and have check sent to pt - there is a check box for this. I even now know how to do secondary claims electronically too. OA help desk taught me

 

thanks Matt I am not sure  we are on the same page - I have been paidPatient  got a perfectly good receipt.I am thinking this is a barrier insurance set sup To get their money or even applied to  deductible the patietn asks fo r help submitting

I never see hcfa and am reluctant to sign  things I cannot verify to the validy of.,( box 17 box  27 whatever, decimal points ...you know?- if involve the biller I would have to pay her so then  charge the patietnI told the patient to call and wrangle with them and to talk to the State bureau of  insuracne  consumer division

ly last year  I used some health care dollars and  Blue Cross -my own-  kept telling me I could not  pay then submit   I only wanted it to go towards teh 5,000 deductible   I tried and they said oh wrong format  and   after a while gave up

I iwll use what I learn from you guys and  pass onto het patient though of course none of you are in MAine The firm is Harvard PIlgrim who are real knuckleheads having let me accredit with them and be a provider then throw me out 1 yr later becasue I would not  join some network where I had to  take all insuracne comers( and it actually hasn't matter much in terms of patients staying or how much who gets paid ).

 

I would do it once, but explain to the patient that if her insurance company requires filing a CMS-1500, then that is the same as you having to file a claim and that in the future you would not be able to offer the discount because you offer the discount so that you don't have to do the 1500.

Having just helped my mom file out of network claims with her instance company (Guardian), I can tell you that they required a copy of a super bill with the diagnosis and CPT codes and a copy of her paid receipt. No MD signature, tho. 

 

Hi I have only a  few people take me up on the  discount, then submit themsleves thing  I am hearing from a woman  who just brought  her kids in that she now needs a   HCFA 1500 filled out  So she emails and  says what is that so I tell her , now she wants my signature  onit!  IF I have to provide servcies it wipes out her discounts... I

 hear form you folks all the time that maybe e some thing was not in the right box  etc   not a clean claim(vomit) so I would not sign it til I c cleared it with my biller who could ok it.. but really is this no the latest trick from insurxnce  that my   bill with  cpt/.icdm/tax id  cannot be used?? ADvice?

--      MD          ph    fax

--      MD          ph    fax

-- M.D.www.elainemd.comOffice:

Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above.

 If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.

--      MD          ph    fax

[Guest guest]

You get paid more in Maine than us poor CA. Can't afford a biller. its not so difficult to bill

 

Thanks everyone Elaine no  no 1500  I  use a biller I I am moslty Medicare some mediciad and also alot of BlueCross a few  others So  no need  for hcfaI have a fabulous biller I thought about office ally but itis really helpful to have a real person to help me for  my sitauioan

 

Jean- your EHR does not spit out a CMS 1500 form? I use OfficeAlly and I plug in DX, CPT code, then put in fee paid and the EHR fills all the rest with everything in the right place. You can send a pft to pt or forwrd to insurnce for them and have check sent to pt - there is a check box for this. I even now know how to do secondary claims electronically too. OA help desk taught me

 

thanks Matt I am not sure  we are on the same page - I have been paidPatient  got a perfectly good receipt.I am thinking this is a barrier insurance set sup To get their money or even applied to  deductible the patietn asks fo r help submitting

I never see hcfa and am reluctant to sign  things I cannot verify to the validy of.,( box 17 box  27 whatever, decimal points ...you know?- if involve the biller I would have to pay her so then  charge the patietnI told the patient to call and wrangle with them and to talk to the State bureau of  insuracne  consumer division

ly last year  I used some health care dollars and  Blue Cross -my own-  kept telling me I could not  pay then submit   I only wanted it to go towards teh 5,000 deductible   I tried and they said oh wrong format  and   after a while gave up

I iwll use what I learn from you guys and  pass onto het patient though of course none of you are in MAine The firm is Harvard PIlgrim who are real knuckleheads having let me accredit with them and be a provider then throw me out 1 yr later becasue I would not  join some network where I had to  take all insuracne comers( and it actually hasn't matter much in terms of patients staying or how much who gets paid ).

 

I would do it once, but explain to the patient that if her insurance company requires filing a CMS-1500, then that is the same as you having to file a claim and that in the future you would not be able to offer the discount because you offer the discount so that you don't have to do the 1500.

Having just helped my mom file out of network claims with her instance company (Guardian), I can tell you that they required a copy of a super bill with the diagnosis and CPT codes and a copy of her paid receipt. No MD signature, tho. 

 

Hi I have only a  few people take me up on the  discount, then submit themsleves thing  I am hearing from a woman  who just brought  her kids in that she now needs a   HCFA 1500 filled out  So she emails and  says what is that so I tell her , now she wants my signature  onit!  IF I have to provide servcies it wipes out her discounts... I

 hear form you folks all the time that maybe e some thing was not in the right box  etc   not a clean claim(vomit) so I would not sign it til I c cleared it with my biller who could ok it.. but really is this no the latest trick from insurxnce  that my   bill with  cpt/.icdm/tax id  cannot be used?? ADvice?

--      MD          ph    fax

--      MD          ph    fax

-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above.

 If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.

--      MD          ph    fax

-- M.D.www.elainemd.comOffice: Go in the directions of your dreams and live the life you've imagined.

This email transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information. The information is intended only for the use of the individual or entity named above.

 If you are not the intended recipient of this material, you may not use, publish, discuss, disseminate or otherwise distribute it. If you are not the intended recipient, or if you have received this transmission in error, please notify the sender immediately and confidentially destroy the information that email in error.