Re: Your opinion about the following insurances

[Guest guest]

I suspect doing this type of advising could be construed as restraint of trade and inflammatory collusion.

Marius --

If you want to have this kind of conversation, please take this off list.

My opinion...

Matt in Western PA

Your opinion about the following insurances

I am thinking to contract with the following insurances but wouldappreciate your recommendations first as to which insurances I shoulddefinitely avoid. E.g. somebody mentioned United and Aetna. I am inOlympia, WA.1. Regence Blue Shield2. Premera Blue Cross3. Cigna4. Aetna5. Uniform6. United7. Kitsap Physician Services8. Tricare (I was told to accept only Tricare Standard)9. Labor and Industries10. First Choice(I omitted Medicaid and Medicare as they are obvious contenders)On that note, what do you think about limiting my practice to the 5major insurances in order to avoid confusion with different regulations?Thanks for your input, Marius

[Guest guest]

In retrospect, I wouldn't have signed up for Tricare due to high referral hassle factor. Medicare is much easier to deal with.I don't have many/ any patients on Tricare Standard.Mostly Prime and Remote. Imagine poorly managed, managed care. This is it.Ben Brewer MD

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[Guest guest]

I think this is a great forum for

this. The only risk we have in discussing our billing structures are in

price collusion efforts. (For example, three of four doctors in one town

decide to set their prices at $x.) We are spread out over the entire

country. We might represent 2-3% of the doctors in the Rochester, NY

area, but this is about as high a concentration as we get. (I called on

this issue to US Attorneys Office last year. This is their unofficial

opinion. Their official opinion takes lots of time and energy.) Individual

contracts usually prevent publishing reimbursement rates.

I would select the major insurance

companies and skip the rest. But make sure you take the higher paying

insurance companies. They will be able to tell you what their reimbursement

is in $/RBRVU if you call their provider relations numbers.

My favorites are below:

1. Regence Blue Shield (We take Premera through Regence)

3. Cigna

4. Aetna

10. First Choice

Providence Health Plans (They have quite a few medications that require

pre-auths.)

We don’t take:

6. United (We dropped them and receiving their letter that we

were no longer associated in anyway is one of my favorites to look at.)

9. Labor and Industries

Motor Vehicle Accidents without a credit card number taken in advance.

We don’t take more of:

5. Uniform (Low reimbursement)

8. Tricare (Low reimbursement, High Hassle)

Medicare (Low reimbursement, High Hassle)

Medicaid (No reimbursement, High Hassle)

I would check around for an IPA in your

area. We get far better rates through our IPA than we do through

individual negotiation.

We don’t have Kitsap Physician

Services in our area.

Ernie

From: [mailto: ] On Behalf Of Marius Laumans

Sent: Thursday, October 04, 2007

3:36 PM

To:

Subject:

Your opinion about the following insurances

I am thinking to contract with the following

insurances but would

appreciate your recommendations first as to which insurances I should

definitely avoid. E.g. somebody mentioned United and Aetna.

I am in

Olympia, WA.

1. Regence Blue Shield

2. Premera Blue Cross

3. Cigna

4. Aetna

5. Uniform

6. United

7. Kitsap Physician Services

8. Tricare (I was told to accept only Tricare Standard)

9. Labor and Industries

10. First Choice

(I omitted Medicaid and Medicare as they are obvious contenders)

On that note, what do you think about limiting my practice to the 5

major insurances in order to avoid confusion with different regulations?

Thanks for your input, Marius

[Guest guest]

I agree with Ernie.

United has many difficulties: 1. Zero respect for doctors or patients as evidenced by their poor customer service and inability to get a human to respond to reimbursement issues. 2. Do not honor the modifier 25. 3. 90 day filing limit. Dropped them like hot potato in July after the fiasco of wanting to fine doctors for patients using the " wrong " lab.

Cigna also does not pay the modifier 25.

Tricare has pitiful reimbursement.

I am " nonparticipating " status with Medicare. Medicare is my worst reimbursement, but the cash at the time of service is nice. (My patients get reimbursed from Medicare about 3 weeks after we file for them.)

Never got paid by Medicaid, so dropped them a year ago.

I definitely agree with looking into any available IPA, as they almost always negotiate better rates.

Good luck

Durango, CO

I think this is a great forum for this. The only risk we have in discussing our billing structures are in price collusion efforts. (For example, three of four doctors in one town decide to set their prices at $x.) We are spread out over the entire country. We might represent 2-3% of the doctors in the Rochester, NY area, but this is about as high a concentration as we get. (I called on this issue to US Attorneys Office last year. This is their unofficial opinion. Their official opinion takes lots of time and energy.) Individual contracts usually prevent publishing reimbursement rates.

I would select the major insurance companies and skip the rest. But make sure you take the higher paying insurance companies. They will be able to tell you what their reimbursement is in $/RBRVU if you call their provider relations numbers.

My favorites are below:

1. Regence Blue Shield (We take Premera through Regence)3. Cigna4. Aetna10. First ChoiceProvidence Health Plans (They have quite a few medications that require pre-auths.)

We don't take:

6. United (We dropped them and receiving their letter that we were no longer associated in anyway is one of my favorites to look at.)

9. Labor and Industries

Motor Vehicle Accidents without a credit card number taken in advance.

We don't take more of:

5. Uniform (Low reimbursement)8. Tricare (Low reimbursement, High Hassle)Medicare (Low reimbursement, High Hassle)

Medicaid (No reimbursement, High Hassle)

I would check around for an IPA in your area. We get far better rates through our IPA than we do through individual negotiation.

We don't have Kitsap Physician Services in our area.

Ernie

From:

[mailto: ] On Behalf Of Marius Laumans

Sent: Thursday, October 04, 2007 3:36 PMTo:

Subject: Your opinion about the following insurances

I am thinking to contract with the following insurances but wouldappreciate your recommendations first as to which insurances I shoulddefinitely avoid. E.g. somebody mentioned United and Aetna. I am inOlympia, WA.1. Regence Blue Shield2. Premera Blue Cross3. Cigna4. Aetna5. Uniform6. United7. Kitsap Physician Services8. Tricare (I was told to accept only Tricare Standard)

9. Labor and Industries10. First Choice(I omitted Medicaid and Medicare as they are obvious contenders)On that note, what do you think about limiting my practice to the 5major insurances in order to avoid confusion with different regulations?

Thanks for your input, Marius

[Guest guest]

I'm still " shadowing " on the listserv and I still work for US

HealthWorks urgent care in Spokane. We have lots of experience with

L & I, and it is certainly the best and consistent payor. There were

some posts on the listserv discussing this issue earlier this year

which could be helpful if you could find them. I think Lawrence Lyons

had a rather extensive post about L & I awhile back as well. L & I

requires a truly intensive amount of paperwork, but it may not be that

much worse than some managed care companies from the sound of things.

We bill far more 99214 than anything else to L & I and the last I

checked we are getting reimbursed about $130 for it. The average for

a new L & I claim varies per individual doc in US HealthWorks of course,

but it's generally around $330-$360.

Regence/Asuris is OK but US HealthWorks has had an ongoing battle with

them downcoding, etc. I'm not quite sure how well they work for

individual docs.

I think the bulk of " private " patients (i.e., not worker comp or L & I)

in US HealthWorks are Premera and we do pretty well with them.

US HealthWorks doesn't accept Medicare or Tricare. The whole issue in

Medicare of not having a two-tiered system for charges was the major

sticking point, I believe. We did accept Medicare until around 2003

but were getting reimbursed around 50% of allowable charges at that time.

Jerry Park

>

> I am thinking to contract with the following insurances but would

> appreciate your recommendations first as to which insurances I should

> definitely avoid. E.g. somebody mentioned United and Aetna. I am in

> Olympia, WA.

>

> 1. Regence Blue Shield

> 2. Premera Blue Cross

> 3. Cigna

> 4. Aetna

> 5. Uniform

> 6. United

> 7. Kitsap Physician Services

> 8. Tricare (I was told to accept only Tricare Standard)

> 9. Labor and Industries

> 10. First Choice

>

> (I omitted Medicaid and Medicare as they are obvious contenders)

>

> On that note, what do you think about limiting my practice to the 5

> major insurances in order to avoid confusion with different regulations?

>

> Thanks for your input, Marius

>

[Guest guest]

Goes to show the variation...I'm in KY and Cigna just about the worst payer I

take, they never

honor -25 or any of the after hours or holiday codes...

Annie

------- Original Message -------

From : mkcl6@...

Sent : 10/6/2007 7:13:57 AM

To :

Cc :

Subject : RE: Re: Your opinion about the following

insurances

Cigna is one of my best in the area of reimbursement, but I think it is

because of the contract negotiated from the local IPA as suggested by Ernie.

Always get the mod 25 also. In Ohio, Medicare is one of the top with regards

to

reimbursement. Sounds like United is the same everywhere (as is Tricare).

I think you probably need to talk to some people that are right in your

region.

************************************** See what's new at http://www.aol.com

[Guest guest]



RE compairing payors.

OK, perhaps I'll contribute so I can also be NOT held to the higher standard of collusion.

Western PA--

1) Medicare reasonable payor -- about $79 for 99214.

2) Commercial payors about $10 more. Many WILL pay -25 modifier, but you have to check each one.

3) Cigna and Aetna are horrible.

4) Won't even touch United Healthcare and most other independent docs won't either.

5) Medical assistance pays all of $31/visit now, up from $29.97. Forget "holiday or after hours" codes, won't touch that.

BCBS really holds 70% of market, and has been fairly responsible.

Matt in Western PA

Hi Annie -- if it stays this warm into November, we'll have to come down and have my 10 year old ride your horse for sure!

RE: Re: Your opinion about the following insurances

Goes to show the variation...I'm in KY and Cigna just about the worst payer I take, they never honor -25 or any of the after hours or holiday codes...Annie------- Original Message -------From : mkcl6@...Sent : 10/6/2007 7:13:57 AMTo : Cc : Subject : RE: Re: Your opinion about the following insurancesCigna is one of my best in the area of reimbursement, but I think it is because of the contract negotiated from the local IPA as suggested by Ernie. Always get the mod 25 also. In Ohio, Medicare is one of the top with regards to reimbursement. Sounds like United is the same everywhere (as is Tricare). I think you probably need to talk to some people that are right in your region. ************************************** See what's new at http://www.aol.com

[Guest guest]

I am in the Puget Sound north of you. I take First choice, although it's a million small plans, they are the highest payor. Regence and Premera, are the majority of my patients, reasonable payors. I aslo take Cigna, and Aetna, not bad in this area of country. I dropped United Health Care this year, and wish I had never taken them. I don't take Medicaid, Uniform, or Tricare, big hassle factor, and limited reimbursement. I opted out of Medicare.

Hope this helps.

Cote' MDFour Corners Family Medicine.

-------------- Original message --------------

I am thinking to contract with the following insurances but wouldappreciate your recommendations first as to which insurances I shoulddefinitely avoid. E.g. somebody mentioned United and Aetna. I am inOlympia, WA.1. Regence Blue Shield2. Premera Blue Cross3. Cigna4. Aetna5. Uniform6. United7. Kitsap Physician Services8. Tricare (I was told to accept only Tricare Standard)9. Labor and Industries10. First Choice(I omitted Medicaid and Medicare as they are obvious contenders)On that note, what do you think about limiting my practice to the 5major insurances in order to avoid confusion with different regulations?Thanks for your input, Marius