RE: Insurance Payment without physician oversight

[Guest guest]

Hi ,

Keep in mind that a list for private practitioners will be hard to generate

from national data. For instance here in Idaho, many insurances use our

local Blue Cross as their local network instead of having a presence in a

small rural state. Because they follow the local BC rules, we get paid

without a referral. This in no way indicates that the original insurance

allows payment without referral in other states. Also keep in mind that

individual employers still negotiate their own contracts with insurers so

that some insurers that pay without referral for one plan, may have a deal

through an employer via an individual contract that requires a referral.

Any list generated will most likely have to be state specific with sub

sections for certain employers as well.

Maybe the APTA Reimbursement Department has that information. If not, it

may be a good thing to encourage them to consider and get each state to

begin compiling a list.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

thowell@...

This email and any files transmitted with it may contain PRIVILEGED or

CONFIDENTIAL information and may be read or used only by the intended

recipient. If you are not the intended recipient of the email or any of its

attachments, please be advised that you have received this email in error

and that any use, dissemination, distribution, forwarding, printing or

copying of this email or any attached files is strictly prohibited. If you

have received this email in error, please immediately purge it and all

attachments and notify the sender by reply email.

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Ball

Sent: Tuesday, April 27, 2010 5:05 PM

To: ptmanager

Subject: Insurance Payment without physician oversight

Dear Group,

I have been asked by my state association to explore several issues related

to insurance payment without physician referral, as well as to develop a

strategic plan for engaging health plans that do not currently reimburse

without physician order. In that vein, (and not being a private

practitioner) I'd like the help of any and all private practitioners on the

listserv:

What plans do you work with that currently reimburse without physician

referral beyond BCBS?

Are you aware of any resources to assist private practitioners with

identification of such plans?

Over the next few months, I will be compiling the information and will be

happy to post to my website for the benefit of listserv members. Thanks in

advance!

M. Ball, PT, DPT, PhD, MBADoctor of Physical Therapy - Northeast

Rehabilitation, Concord, NCSpinal Manipulative Physical Therapist

__________________________________________________________

The New Busy is not the old busy. Search, chat and e-mail from your inbox.

http://www.windowsl

<http://www.windowslive.com/campaign/thenewbusy?ocid=PID28326::T:WLMTAGL:ON:

WL:en-US:WM_HMP:042010_3>

ive.com/campaign/thenewbusy?ocid=PID28326::T:WLMTAGL:ON:WL:en-US:WM_HMP:0420

10_3