Guest guest Posted May 14, 2004 Report Share Posted May 14, 2004 Just got off the phone with one insurance company. Good news is that they give coverage based on medical necessity, with no limit to number of treatments. Bad news is that they pay 5% of my fee. 5%!?! Charging $65 per treatment, I wouldn't be able to buy a box of needles with their payment, forget paying rent or paying myself! Are all insurance companies so generous with their coverage? Are there any insurance companies in NYC that pay something that is not insulting? Thanks Lauren Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 yes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance. California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature... I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later. Angela Pf, Colorado .. - anne.crowley Chinese Medicine Tuesday, January 23, 2007 5:26 PM Re: Business Mgmt I would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often. I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states? The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less. Anne -------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed > That is quite illegal. > > Avery > > > > > Anne, > > > > I couldn't help but respond to this as it is often misunderstood and > > misapplied. It's not an insurance game to charge " more " for insurance > > billings than for those who are paying " out-of-pocket " . Your real > > price is > > what is charged to insurance and to anyone else who is not going to give > > you > > payment that day of treatment. For example, let's just say for a return > > visit your price is $90. For the patient who pays the same day as > > service, > > a (legal) " payment same day of service discount " is applied. The > > amount of > > that discount is up to you, but I wouldn't recommend anything over 20%. > > So, > > that would make the cash paying patient charge of $72. Your time and > > energy and sometimes months of waiting (and calling repeatedly) is > > accounted > > for in your real (e.g., insurance) rate. Technically, a practitioner > > should offer this same discount to any insurance company that can pay > > their > > bill within 7 days. A note can be sent with billings letting them know > > of > > the savings that can reap by quick payment. There is nothing illegal or > > unethical about this practice. Many MD's and dentists, in my experience, > > offer this type of discount to patients as a thank you for eliminating a > > bunch of waiting and work. > > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145 > > > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author. > > Please consider the environment and only print this message if absolutely > necessary. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 Angela, There have been LAc's, at least one that I know of personally, that have been found guilty of insurance fraud and my thoughts are that more will follow. That will depend upon how much effort the state's boards are about enforcement and investigation. We need to become better educated about what a provider is how we are to conduct business ethically otherwise we can start reading more about ourselves and wonder. Mike W. Bowser, L Ac : angela.pf: Wed, 24 Jan 2007 08:32:00 -0700Re: Insurance yes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance.California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature...I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later.Angela Pf, Colorado.----- Original Message ----- anne.crowley To: Chinese Medicine Tuesday, January 23, 2007 5:26 PMRe: Business MgmtI would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often.I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states?The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less.Anne-------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but respond to this as it is often misunderstood and> > misapplied. It's not an insurance game to charge " more " for insurance> > billings than for those who are paying " out-of-pocket " . Your real > > price is> > what is charged to insurance and to anyone else who is not going to give > > you> > payment that day of treatment. For example, let's just say for a return> > visit your price is $90. For the patient who pays the same day as > > service,> > a (legal) " payment same day of service discount " is applied. The > > amount of> > that discount is up to you, but I wouldn't recommend anything over 20%. > > So,> > that would make the cash paying patient charge of $72. Your time and> > energy and sometimes months of waiting (and calling repeatedly) is > > accounted> > for in your real (e.g., insurance) rate. Technically, a practitioner> > should offer this same discount to any insurance company that can pay > > their> > bill within 7 days. A note can be sent with billings letting them know > > of> > the savings that can reap by quick payment. There is nothing illegal or> > unethical about this practice. Many MD's and dentists, in my experience,> > offer this type of discount to patients as a thank you for eliminating a> > bunch of waiting and work.> > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145> > To change your email delivery settings, click, > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author.> > Please consider the environment and only print this message if absolutely > necessary. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 Angela, How does the CO regulations deal with out-of-network providers (not a member of an HMO) as far as collection of co-pays? Mike W. Bowser, L Ac : angela.pf: Wed, 24 Jan 2007 08:32:00 -0700Re: Insurance yes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance.California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature...I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later.Angela Pf, Colorado.----- Original Message ----- anne.crowley To: Chinese Medicine Tuesday, January 23, 2007 5:26 PMRe: Business MgmtI would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often.I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states?The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less.Anne-------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but respond to this as it is often misunderstood and> > misapplied. It's not an insurance game to charge " more " for insurance> > billings than for those who are paying " out-of-pocket " . Your real > > price is> > what is charged to insurance and to anyone else who is not going to give > > you> > payment that day of treatment. For example, let's just say for a return> > visit your price is $90. For the patient who pays the same day as > > service,> > a (legal) " payment same day of service discount " is applied. The > > amount of> > that discount is up to you, but I wouldn't recommend anything over 20%. > > So,> > that would make the cash paying patient charge of $72. Your time and> > energy and sometimes months of waiting (and calling repeatedly) is > > accounted> > for in your real (e.g., insurance) rate. Technically, a practitioner> > should offer this same discount to any insurance company that can pay > > their> > bill within 7 days. A note can be sent with billings letting them know > > of> > the savings that can reap by quick payment. There is nothing illegal or> > unethical about this practice. Many MD's and dentists, in my experience,> > offer this type of discount to patients as a thank you for eliminating a> > bunch of waiting and work.> > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145> > To change your email delivery settings, click, > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author.> > Please consider the environment and only print this message if absolutely > necessary. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 My understanding is that any time you bill an insurance you have to collect the copay. Not doing so is called " interfering with the insurance agreement " and it's illegal. I don't think it matters if you are in-network or not, it's a state law. Angela Pf .. - mike Bowser Chinese Traditional Medicine Wednesday, January 24, 2007 9:37 AM RE: Insurance Angela, How does the CO regulations deal with out-of-network providers (not a member of an HMO) as far as collection of co-pays? Mike W. Bowser, L Ac : angela.pf: Wed, 24 Jan 2007 08:32:00 -0700Re: TCM - Insurance yes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance.California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature...I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later.Angela Pf, Colorado.----- Original Message ----- anne.crowley To: Chinese Medicine Tuesday, January 23, 2007 5:26 PMRe: Business MgmtI would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often.I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states?The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less.Anne-------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but respond to this as it is often misunderstood and> > misapplied. It's not an insurance game to charge " more " for insurance> > billings than for those who are paying " out-of-pocket " . Your real > > price is> > what is charged to insurance and to anyone else who is not going to give > > you> > payment that day of treatment. For example, let's just say for a return> > visit your price is $90. For the patient who pays the same day as > > service,> > a (legal) " payment same day of service discount " is applied. The > > amount of> > that discount is up to you, but I wouldn't recommend anything over 20%. > > So,> > that would make the cash paying patient charge of $72. Your time and> > energy and sometimes months of waiting (and calling repeatedly) is > > accounted> > for in your real (e.g., insurance) rate. Technically, a practitioner> > should offer this same discount to any insurance company that can pay > > their> > bill within 7 days. A note can be sent with billings letting them know > > of> > the savings that can reap by quick payment. There is nothing illegal or> > unethical about this practice. Many MD's and dentists, in my experience,> > offer this type of discount to patients as a thank you for eliminating a> > bunch of waiting and work.> > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145> > To change your email delivery settings, click, > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author.> > Please consider the environment and only print this message if absolutely > necessary. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 Ethics is a tricky field. Let's say the client can't pay the full fee, and you deny a treatment that they need, is that ethical? Is everything that is legal ethical? I don't think these are easy questions. The legislature is acting on the profit motives of the insurance companies and negecting the real life needs of people who may be poor. That's not ethical to me; it's greed. I personally feel that I should be allowed to give away my services if I feel like it, it's my time! I personally don't feel that something is unethical just because it's not legal, but it's a very personal question; you are the only person who can know what is right for yourself. Angela .. - mike Bowser Chinese Traditional Medicine Wednesday, January 24, 2007 9:34 AM RE: Insurance Angela, There have been LAc's, at least one that I know of personally, that have been found guilty of insurance fraud and my thoughts are that more will follow. That will depend upon how much effort the state's boards are about enforcement and investigation. We need to become better educated about what a provider is how we are to conduct business ethically otherwise we can start reading more about ourselves and wonder. Mike W. Bowser, L Ac : angela.pf: Wed, 24 Jan 2007 08:32:00 -0700Re: TCM - Insurance yes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance.California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature...I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later.Angela Pf, Colorado.----- Original Message ----- anne.crowley To: Chinese Medicine Tuesday, January 23, 2007 5:26 PMRe: Business MgmtI would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often.I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states?The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less.Anne-------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but respond to this as it is often misunderstood and> > misapplied. It's not an insurance game to charge " more " for insurance> > billings than for those who are paying " out-of-pocket " . Your real > > price is> > what is charged to insurance and to anyone else who is not going to give > > you> > payment that day of treatment. For example, let's just say for a return> > visit your price is $90. For the patient who pays the same day as > > service,> > a (legal) " payment same day of service discount " is applied. The > > amount of> > that discount is up to you, but I wouldn't recommend anything over 20%. > > So,> > that would make the cash paying patient charge of $72. Your time and> > energy and sometimes months of waiting (and calling repeatedly) is > > accounted> > for in your real (e.g., insurance) rate. Technically, a practitioner> > should offer this same discount to any insurance company that can pay > > their> > bill within 7 days. A note can be sent with billings letting them know > > of> > the savings that can reap by quick payment. There is nothing illegal or> > unethical about this practice. Many MD's and dentists, in my experience,> > offer this type of discount to patients as a thank you for eliminating a> > bunch of waiting and work.> > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145> > To change your email delivery settings, click, > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author.> > Please consider the environment and only print this message if absolutely > necessary. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 Angela, I do not think that your or my definition of ethics is going to be acceptable in any court. There is a legal definition that we must abide by if we are going to continue to remain LAc. As for the insurance game, we need to get single payer, universal coverage healthcare system in place as this and many other issues will become mute. If we get rid of the insurance/HMO control of healthcare, then patients (more choices) will do better and we will get paid. Mike W. Bowser, L Ac : angela.pf: Wed, 24 Jan 2007 09:57:47 -0700Re: Insurance Ethics is a tricky field. Let's say the client can't pay the full fee, and you deny a treatment that they need, is that ethical? Is everything that is legal ethical? I don't think these are easy questions. The legislature is acting on the profit motives of the insurance companies and negecting the real life needs of people who may be poor. That's not ethical to me; it's greed. I personally feel that I should be allowed to give away my services if I feel like it, it's my time!I personally don't feel that something is unethical just because it's not legal, but it's a very personal question; you are the only person who can know what is right for yourself. Angela.- mike Bowser Chinese Traditional Medicine Wednesday, January 24, 2007 9:34 AMRE: InsuranceAngela,There have been LAc's, at least one that I know of personally, that have been found guilty of insurance fraud and my thoughts are that more will follow. That will depend upon how much effort the state's boards are about enforcement and investigation. We need to become better educated about what a provider is how we are to conduct business ethically otherwise we can start reading more about ourselves and wonder. Mike W. Bowser, L Ac: angela.pf: Wed, 24 Jan 2007 08:32:00 -0700Re: TCM - Insuranceyes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance.California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature...I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later.Angela Pf, Colorado.- anne.crowley To: Chinese Medicine Tuesday, January 23, 2007 5:26 PMRe: Business MgmtI would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often.I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states?The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less.Anne-------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but respond to this as it is often misunderstood and> > misapplied. It's not an insurance game to charge " more " for insurance> > billings than for those who are paying " out-of-pocket " . Your real > > price is> > what is charged to insurance and to anyone else who is not going to give > > you> > payment that day of treatment. For example, let's just say for a return> > visit your price is $90. For the patient who pays the same day as > > service,> > a (legal) " payment same day of service discount " is applied. The > > amount of> > that discount is up to you, but I wouldn't recommend anything over 20%. > > So,> > that would make the cash paying patient charge of $72. Your time and> > energy and sometimes months of waiting (and calling repeatedly) is > > accounted> > for in your real (e.g., insurance) rate. Technically, a practitioner> > should offer this same discount to any insurance company that can pay > > their> > bill within 7 days. A note can be sent with billings letting them know > > of> > the savings that can reap by quick payment. There is nothing illegal or> > unethical about this practice. Many MD's and dentists, in my experience,> > offer this type of discount to patients as a thank you for eliminating a> > bunch of waiting and work.> > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145> > To change your email delivery settings, click, > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author.> > Please consider the environment and only print this message if absolutely > necessary. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 Angela, I find this odd as it implies that everyone is now a network provider, kind of like forced labor or fixed pricing. That would also imply that all your state LAc are now HIPAA compliant (patient can send in a bill but you must collect the copay). I know in the past that many LAc have tried to opt out by having a cash-only practice. Has you licensing board made any determinations on this?Mike W. Bowser, L Ac : angela.pf: Wed, 24 Jan 2007 09:49:53 -0700Re: Insurance My understanding is that any time you bill an insurance you have to collect the copay. Not doing so is called " interfering with the insurance agreement " and it's illegal. I don't think it matters if you are in-network or not, it's a state law. Angela Pf.- mike Bowser To: Chinese Traditional Medicine Wednesday, January 24, 2007 9:37 AMRE: InsuranceAngela,How does the CO regulations deal with out-of-network providers (not a member of an HMO) as far as collection of co-pays? Mike W. Bowser, L AcTo: Chinese Medicine: angela.pf: Wed, 24 Jan 2007 08:32:00 -0700Re: Insuranceyes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance.California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature...I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later.Angela Pf, Colorado.- anne.crowley Chinese Medicine Sent: Tuesday, January 23, 2007 5:26 PMRe: Business MgmtI would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often.I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states?The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less.Anne-------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but respond to this as it is often misunderstood and> > misapplied. It's not an insurance game to charge " more " for insurance> > billings than for those who are paying " out-of-pocket " . Your real > > price is> > what is charged to insurance and to anyone else who is not going to give > > you> > payment that day of treatment. For example, let's just say for a return> > visit your price is $90. For the patient who pays the same day as > > service,> > a (legal) " payment same day of service discount " is applied. The > > amount of> > that discount is up to you, but I wouldn't recommend anything over 20%. > > So,> > that would make the cash paying patient charge of $72. Your time and> > energy and sometimes months of waiting (and calling repeatedly) is > > accounted> > for in your real (e.g., insurance) rate. Technically, a practitioner> > should offer this same discount to any insurance company that can pay > > their> > bill within 7 days. A note can be sent with billings letting them know > > of> > the savings that can reap by quick payment. There is nothing illegal or> > unethical about this practice. Many MD's and dentists, in my experience,> > offer this type of discount to patients as a thank you for eliminating a> > bunch of waiting and work.> > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145> > To change your email delivery settings, click, > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author.> > Please consider the environment and only print this message if absolutely > necessary. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 Mike, If we get single payor universal health care, we will get a newfangled version of Medicare, and indeed those issues will become moot because we will all go out of business. Avery Avery L. Jenkins, DC, FIAMA, DACBN Chiropractic Physician Fellow, International Academy of Medical Acupuncturists Diplomate, American Clinical Board of Nutrition www.docaltmed.com -- -- E-MAIL CONFIDENTIALITY NOTICE - This transmission may be: (1) subject to Physician-Patient confidentiality, or, (2) strictly confidential. If you are not the intended recipient of this message, you may not disclose, print, copy or disseminate this information under the Health Insurance Portability and Accountability Act. If you have received this in error, please reply and notify the sender (only) and delete the message. Unauthorized interception of this e-mail is a violation of federal criminal law. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 My understanding is that if you are cash and carry only, co-pays don't apply. But say, a client asks me to send to the insurance. Even if I am not in-network, I need to collect the co-pay. Such insurances become more rare, but they do exist. I need to collect the copay because I am a licensed provider in Colorado and there is a law in Colorado that says providers are not allowed to interfere with insurance contracts and agreements. It does not apply to Ac alone, all providers are included. I think this is new in the last few years; before insurances tried to regulate provider behavior, but they had no real teeth, now they succeeded in creating state laws that support them. I don't know how other states regulate this issue, Colorado is very Republican, big-business oriented. My understanding of HIPPA compliance is that it depends if you ever electronically communicate at all, if yes, you need to become compliant even if you do not file for insurance. If there is no electronic communication ever, you do not need to become compliant. A lawyer with a health care license explained that to me; however I am not 100% sure about faxes, but it does apply to internet communications, including all emails. For me HIPPA compliance mainly means giving clients the disclosure sheet and obtaining the signature. Angela Pf .. - mike Bowser Chinese Traditional Medicine Wednesday, January 24, 2007 12:56 PM RE: Insurance Angela, I find this odd as it implies that everyone is now a network provider, kind of like forced labor or fixed pricing. That would also imply that all your state LAc are now HIPAA compliant (patient can send in a bill but you must collect the copay). I know in the past that many LAc have tried to opt out by having a cash-only practice. Has you licensing board made any determinations on this?Mike W. Bowser, L Ac : angela.pf: Wed, 24 Jan 2007 09:49:53 -0700Re: TCM - Insurance My understanding is that any time you bill an insurance you have to collect the copay. Not doing so is called " interfering with the insurance agreement " and it's illegal. I don't think it matters if you are in-network or not, it's a state law. Angela Pf.- mike Bowser To: Chinese Traditional Medicine Wednesday, January 24, 2007 9:37 AMRE: InsuranceAngela,How does the CO regulations deal with out-of-network providers (not a member of an HMO) as far as collection of co-pays? Mike W. Bowser, L AcTo: Chinese Medicine: angela.pf: Wed, 24 Jan 2007 08:32:00 -0700Re: Insuranceyes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance.California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature...I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later.Angela Pf, Colorado.- anne.crowley Chinese Medicine Sent: Tuesday, January 23, 2007 5:26 PMRe: Business MgmtI would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often.I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states?The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less.Anne-------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but respond to this as it is often misunderstood and> > misapplied. It's not an insurance game to charge " more " for insurance> > billings than for those who are paying " out-of-pocket " . Your real > > price is> > what is charged to insurance and to anyone else who is not going to give > > you> > payment that day of treatment. For example, let's just say for a return> > visit your price is $90. For the patient who pays the same day as > > service,> > a (legal) " payment same day of service discount " is applied. The > > amount of> > that discount is up to you, but I wouldn't recommend anything over 20%. > > So,> > that would make the cash paying patient charge of $72. Your time and> > energy and sometimes months of waiting (and calling repeatedly) is > > accounted> > for in your real (e.g., insurance) rate. Technically, a practitioner> > should offer this same discount to any insurance company that can pay > > their> > bill within 7 days. A note can be sent with billings letting them know > > of> > the savings that can reap by quick payment. There is nothing illegal or> > unethical about this practice. Many MD's and dentists, in my experience,> > offer this type of discount to patients as a thank you for eliminating a> > bunch of waiting and work.> > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145> > To change your email delivery settings, click, > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author.> > Please consider the environment and only print this message if absolutely > necessary. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2007 Report Share Posted January 24, 2007 Angela, My point about all your state LAc's needing to be HIPAA complaint was in reference to even if you are cash and your patient wants to bill their own insurance, now by this law you must be also. You see, you are not any longer in control of your own business. Kind of scary. HIPAA applies to any and all electronic means of patient info. Some states also have laws about treatment of patient records. Your fax or phone usage makes you a HIPAA covered entity if you are discussing patient info. So, how do you deal with a cash patient who wants to send in their own superbill (or you want them to)? Do you call their insurance and find out their deductible and subtract this amount and take the remainder? Do you see where I am going with this? It sounds like all CO LAc are now required to participate in the insurance game. Do you run a cash-only practice and if so, how do you avoid the above issues? Just curious.Mike W. Bowser, L Ac : angela.pf: Wed, 24 Jan 2007 13:57:04 -0700Re: Insurance My understanding is that if you are cash and carry only, co-pays don't apply. But say, a client asks me to send to the insurance. Even if I am not in-network, I need to collect the co-pay. Such insurances become more rare, but they do exist. I need to collect the copay because I am a licensed provider in Colorado and there is a law in Colorado that says providers are not allowed to interfere with insurance contracts and agreements. It does not apply to Ac alone, all providers are included.I think this is new in the last few years; before insurances tried to regulate provider behavior, but they had no real teeth, now they succeeded in creating state laws that support them.I don't know how other states regulate this issue, Colorado is very Republican, big-business oriented. My understanding of HIPPA compliance is that it depends if you ever electronically communicate at all, if yes, you need to become compliant even if you do not file for insurance. If there is no electronic communication ever, you do not need to become compliant. A lawyer with a health care license explained that to me; however I am not 100% sure about faxes, but it does apply to internet communications, including all emails. For me HIPPA compliance mainly means giving clients the disclosure sheet and obtaining the signature.Angela Pf.- mike Bowser To: Chinese Traditional Medicine Wednesday, January 24, 2007 12:56 PMRE: InsuranceAngela,I find this odd as it implies that everyone is now a network provider, kind of like forced labor or fixed pricing. That would also imply that all your state LAc are now HIPAA compliant (patient can send in a bill but you must collect the copay). I know in the past that many LAc have tried to opt out by having a cash-only practice. Has you licensing board made any determinations on this?Mike W. Bowser, L AcTo: Chinese Medicine: angela.pf: Wed, 24 Jan 2007 09:49:53 -0700Re: InsuranceMy understanding is that any time you bill an insurance you have to collect the copay. Not doing so is called " interfering with the insurance agreement " and it's illegal. I don't think it matters if you are in-network or not, it's a state law. Angela Pf.----- Original Message ----- mike Bowser To: Chinese Traditional Medicine Wednesday, January 24, 2007 9:37 AMRE: InsuranceAngela,How does the CO regulations deal with out-of-network providers (not a member of an HMO) as far as collection of co-pays? Mike W. Bowser, L AcTo: Chinese Medicine: angela.pf: Wed, 24 Jan 2007 08:32:00 -0700Re: Insuranceyes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance.California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature...I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later.Angela Pf, Colorado.- anne.crowley Chinese Medicine Sent: Tuesday, January 23, 2007 5:26 PMRe: Business MgmtI would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often.I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states?The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less.Anne-------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but respond to this as it is often misunderstood and> > misapplied. It's not an insurance game to charge " more " for insurance> > billings than for those who are paying " out-of-pocket " . Your real > > price is> > what is charged to insurance and to anyone else who is not going to give > > you> > payment that day of treatment. For example, let's just say for a return> > visit your price is $90. For the patient who pays the same day as > > service,> > a (legal) " payment same day of service discount " is applied. The > > amount of> > that discount is up to you, but I wouldn't recommend anything over 20%. > > So,> > that would make the cash paying patient charge of $72. Your time and> > energy and sometimes months of waiting (and calling repeatedly) is > > accounted> > for in your real (e.g., insurance) rate. Technically, a practitioner> > should offer this same discount to any insurance company that can pay > > their> > bill within 7 days. A note can be sent with billings letting them know > > of> > the savings that can reap by quick payment. There is nothing illegal or> > unethical about this practice. Many MD's and dentists, in my experience,> > offer this type of discount to patients as a thank you for eliminating a> > bunch of waiting and work.> > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar.thebizplace.com/LandingPage.aspx/CT145145> > To change your email delivery settings, click, > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author.> > Please consider the environment and only print this message if absolutely > necessary. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2007 Report Share Posted January 25, 2007 Avery, I have to disagree with you completely as the HMO's have failed their mandate. Right now we are seeing less insurance coverage and those who run cash practices are not doing well either. Our economy is going down while HMO's are going up. We have an organization in MN (MUHCC) that is working on this issue by educating the public and policy makers about our current problems with allowing a free-for-all mentality to continue for healthcare. The objectives are simple. Separate employment from healthcare, reduce wasteful spending (HMO's tend to have very high admin costs in the area of 30%, while Medicare is at 2.5%) , allow for patient choice of provider (even specialties w/o a referral), eliminate doctor incentives for not referring, etc. If you want to discuss this more, I would be happy to or can encourage you to check out the website at http://www.muhcc.org/. Mike W. Bowser, L Ac http://maps.live.com/?wip=51 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2007 Report Share Posted January 25, 2007 Here are the two situations I know of that resulted in a practitioner being charged with insurance fraud. 1) The provider did not collect or charge the co-payment. 2) In the case of a patient with a large deductible, the provider accepted a reduced cash payment for services the same day, but submitted a bill to the insurance for full price thereby giving the patient much more credit toward their deductible than they really paid. As for the legality of same-day-as-service discount, it is legal in my state (Washington) and California for certain. It doesn't make sense to me how something like this could be so different from state-to-state. The older I get, the more I feel we are really 50 different countries rather than states. The most important thing to remember is to be very consistent and have keep good records. And, amen to the comment about getting rid of the HMO grip on all of medicine in the U.S. _____ Chinese Medicine Chinese Medicine On Behalf Of mike Bowser Wednesday, January 24, 2007 11:50 AM Chinese Traditional Medicine RE: Insurance Angela, I do not think that your or my definition of ethics is going to be acceptable in any court. There is a legal definition that we must abide by if we are going to continue to remain LAc. As for the insurance game, we need to get single payer, universal coverage healthcare system in place as this and many other issues will become mute. If we get rid of the insurance/HMO control of healthcare, then patients (more choices) will do better and we will get paid. Mike W. Bowser, L Ac Traditional_ <Chinese Medicine%40From> Chinese_Medicine: angela.pf (AT) comcast (DOT) <angela.pf%40comcast.netDate> netWed, 24 Jan 2007 09:57:47 -0700Re: Insurance Ethics is a tricky field. Let's say the client can't pay the full fee, and you deny a treatment that they need, is that ethical? Is everything that is legal ethical? I don't think these are easy questions. The legislature is acting on the profit motives of the insurance companies and negecting the real life needs of people who may be poor. That's not ethical to me; it's greed. I personally feel that I should be allowed to give away my services if I feel like it, it's my time!I personally don't feel that something is unethical just because it's not legal, but it's a very personal question; you are the only person who can know what is right for yourself. Angela.- mike Bowser traditional_ <Chinese Traditional Medicine%40> chinese_medicine Wednesday, January 24, 2007 9:34 AMRE: InsuranceAngela,There have been LAc's, at least one that I know of personally, that have been found guilty of insurance fraud and my thoughts are that more will follow. That will depend upon how much effort the state's boards are about enforcement and investigation. We need to become better educated about what a provider is how we are to conduct business ethically otherwise we can start reading more about ourselves and wonder. Mike W. Bowser, L AcTraditional_ <Chinese Medicine%40From> Chinese_Medicine: angela.pf (AT) comcast (DOT) <angela.pf%40comcast.netDate> netWed, 24 Jan 2007 08:32:00 -0700Re: Insuranceyes, regulation of fees varies by state. I know that Colorado specifically forbids NOT collecting copays, it also states that only small discounts for cash payments are allowed, Oregon also explicitly states that your charges have to be consistent, meaning you cannot have a higher payscale for insurance.California obviously allows any discount as long as the client is not insured. I guess it all comes down to how influential the insurance industry is and how much they are able to influence the legislature...I am not sure I have ever heard of an individual practitioner getting caught and punished, but I know that some of my clients have sent in bills to their insurance that I only later found out about. I also know that an insurance company went after a subsection of the local hospital for giving free or strongly reduced counseling to clients in need and the hospital had to pay punitive fees later.Angela Pf, Colorado.----- Original Message ----- anne.crowley@ <anne.crowley%40comcast.net> comcast.net Traditional_ <Chinese Medicine%40> Chinese_Medicine Tuesday, January 23, 2007 5:26 PMRe: Business MgmtI would like to hear more on this. Barabara thinks it is okay and Avery thinks it is illegal. I think chiros do the range of fees often.I always thought you had to charge everyone the same and could give someone a discount based on need. Is this different for different states?The insurance game I was talking about was charging insurance 200 per treatment and between the copay and the reimbursement practitioner got 95, was a member of the plan and was paid pretty well based on this. I know they don't charge everyone that - quite a lot less.Anne-------------- Original message ---------------------- " Dr. Avery Jenkins " <docaltmed@sbcglobal <docaltmed%40sbcglobal.net> ..net>> That is quite illegal.> > Avery> > > > > Anne,> >> > I couldn't help but respond to this as it is often misunderstood and> > misapplied. It's not an insurance game to charge " more " for insurance> > billings than for those who are paying " out-of-pocket " . Your real > > price is> > what is charged to insurance and to anyone else who is not going to give > > you> > payment that day of treatment. For example, let's just say for a return> > visit your price is $90. For the patient who pays the same day as > > service,> > a (legal) " payment same day of service discount " is applied. The > > amount of> > that discount is up to you, but I wouldn't recommend anything over 20%. > > So,> > that would make the cash paying patient charge of $72. Your time and> > energy and sometimes months of waiting (and calling repeatedly) is > > accounted> > for in your real (e.g., insurance) rate. Technically, a practitioner> > should offer this same discount to any insurance company that can pay > > their> > bill within 7 days. A note can be sent with billings letting them know > > of> > the savings that can reap by quick payment. There is nothing illegal or> > unethical about this practice. Many MD's and dentists, in my experience,> > offer this type of discount to patients as a thank you for eliminating a> > bunch of waiting and work.> > > Subscribe to the new FREE online journal for TCM at Times > http://www.chinesem <http://www.chinesemedicinetimes.com> edicinetimes.com > > Download the all new TCM Forum Toolbar, click, > http://toolbar. <http://toolbar.thebizplace.com/LandingPage.aspx/CT145145> thebizplace.com/LandingPage.aspx/CT145145> > To change your email delivery settings, click, > http://groups. <> and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author.> > Please consider the environment and only print this message if absolutely > necessary. > Groups Links> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2007 Report Share Posted January 25, 2007 On Jan 25, 2007, at 2:28 AM, Chinese Medicine wrote: > My point about all your state LAc's needing to be HIPAA complaint > was in reference to even if you are cash and your patient wants to > bill their own insurance, now by this law you must be also. You > see, you are not any longer in control of your own business. Kind > of scary. > > HIPAA applies to any and all electronic means of patient info. > Some states also have laws about treatment of patient records. > Your fax or phone usage makes you a HIPAA covered entity if you are > discussing patient info. > So, how do you deal with a cash patient who wants to send in their > own superbill (or you want them to)? Do you call their insurance > and find out their deductible and subtract this amount and take the > remainder? Do you see where I am going with this? It sounds like > all CO LAc are now required to participate in the insurance game. > Do you run a cash-only practice and if so, how do you avoid the > above issues? > > Just curious.Mike W. Bowser, L Ac I have a cash practice in Colorado. I am also HIPAA compliant. This means that all of my patient related files and communications on my computer are password protected. I have all my patients sign a HIPAA policy sheet along with the state required disclosure and consent to treat forms and keep these on file in a locked filing cabinet. My patients pay the full fee at the time of service and I give them a superbill which they can submit for reimbursement or not as they choose. Insurance doesn't have much impact on my business one way or another. Judy Lemieux, M.S., L.Ac. In Denver & Centennial, Colorado (303) 964-1996 http://www.QingTingAcupuncture.com Acupuncture Association of Colorado President http://www.acucol.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2007 Report Share Posted January 25, 2007 Judy, You have done all the things that HIPAA would require anyway.Great work.Mike W. Bowser, L Ac : jsaxe: Thu, 25 Jan 2007 09:24:51 -0700TCM - Re: Insurance On Jan 25, 2007, at 2:28 AM, Chinese Medicine wrote:> My point about all your state LAc's needing to be HIPAA complaint > was in reference to even if you are cash and your patient wants to > bill their own insurance, now by this law you must be also. You > see, you are not any longer in control of your own business. Kind > of scary.>> HIPAA applies to any and all electronic means of patient info. > Some states also have laws about treatment of patient records. > Your fax or phone usage makes you a HIPAA covered entity if you are > discussing patient info.> So, how do you deal with a cash patient who wants to send in their > own superbill (or you want them to)? Do you call their insurance > and find out their deductible and subtract this amount and take the > remainder? Do you see where I am going with this? It sounds like > all CO LAc are now required to participate in the insurance game. > Do you run a cash-only practice and if so, how do you avoid the > above issues?>> Just curious.Mike W. Bowser, L AcI have a cash practice in Colorado. I am also HIPAA compliant. This means that all of my patient related files and communications on my computer are password protected. I have all my patients sign a HIPAA policy sheet along with the state required disclosure and consent to treat forms and keep these on file in a locked filing cabinet. My patients pay the full fee at the time of service and I give them a superbill which they can submit for reimbursement or not as they choose. Insurance doesn't have much impact on my business one way or another.Judy Lemieux, M.S., L.Ac.In Denver & Centennial, Colorado(303) 964-1996http://www.QingTingAcupuncture.comAcupuncture Association of ColoradoPresidenthttp://www.acucol.com _______________ Fixing up the home? Live Search can help. http://imagine-windowslive.com/search/kits/default.aspx?kit=improve & locale=en-US\ & source=wlmemailtaglinenov06 Quote Link to comment Share on other sites More sharing options...
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