conducting insurance & pre-payment of services

[Guest guest]

Natalie has been in OAA for years and past president several times.Please note

this information is specific for Oregon. Pam Price

 

-

Natalie Arndt

AAArndt, Natalie

Wednesday, December 22, 2004 7:48 PM

conducting insurance & pre-payment of services

 

 

FYI---

 

Prepayment of Services

Nat talked to someone at the Oregon Insurance Division (ie Insurance

Commissioner) on 12-22-04 and asked whether pre-payment of services is

considered conducting insurance and therefore would require a license to conduct

insurance.

 

(Note- regarding an official statement on Time of Service Discounts & Sliding

Scale fee schedules, OAA would need to write the Insurance Commissioner.

 

The response will take at least 1 month.)

 

 

 

Here is the info, see the examples below. (No laws/codes were cited.)

 

a-Payment ahead for specific services is not conducting insurance.

 

b-Giving the client a discount for paying ahead for specific services is not

conducting insurance.

 

c-It is considered conducting insurance if the provider promises to cover

" uncertain needs or costs " for a certain time period, ie " bearing the risk " for

the client.

 

 

 

Examples:

 

Situation a- You offer a stop smoking series of 4 treatments for $200, and they

pay the $200 at the first visit. You are not conducting insurance.

 

Situation b- The patient will do a 5-treatment series to treat their back pain.

Each treatment costs $60. You accept $260 for the 5 treatments, if they pay the

$260 at the 1st treatment (or ahead of time.) You are not conducting insurance.

 

Situation c- The client pays $200 and the provider promises to cover anything

they need during the 2 week time period when they are quitting smoking. This

provider is conducting insurance.

 

 

 

Item " c " is interesting since an MD is currently offering patients to pay a lump

sum for complete care for a year at a time.

 

These arrangements are called " boutique " plans and the approach is being

investigated as to whether this is " conducting insurance " and needs to be

regulated as such.

 

 

Nat's note-

 

We spoke w/an atty on the issue of cash discount and recieved this impression

from the atty:

 

You must charge everyone the same fees. You can accept different amounts for

payments if the rationale is " defense-able " , reasonable, and consistent. " All

providers need to have one " fee schedule " , i.e., charge everyone the same-

insurance, private pay patients, etc.

 

We'll have more explanation on this soon.

 

 

 

Nat

 

 

[Guest guest]

Pam,

 

Thanks for taking the time to offer this information. I know it's a

state by state decision. The American Acupuncture Council asks if you

accept prepays when you are renewing. Then I hear they defer back to

the state insurance commission. If anyone knows the rules in Maryland,

I'd like to know. On the discounts, yes, I had heard this a while ago.

Charge everyone the same fee, whether they have insurance or not, and

there will be patients that may qualify for a sliding scale or reduced

fee based on income needs. It appears the attorney is saying your

" payment received " vs. your fee has to be defensible, reasonable and

consistent.

 

Anne

 

Pam Price wrote:

 

>

> Natalie has been in OAA for years and past president several

> times.Please note this information is specific for Oregon. Pam Price

>

> -

> Natalie Arndt

> AAArndt, Natalie

> Wednesday, December 22, 2004 7:48 PM

> conducting insurance & pre-payment of services

>

>

> FYI---

>

> Prepayment of Services

> Nat talked to someone at the Oregon Insurance Division (ie Insurance

> Commissioner) on 12-22-04 and asked whether pre-payment of services is

> considered conducting insurance and therefore would require a license

> to conduct insurance.

>

> (Note- regarding an official statement on Time of Service Discounts &

> Sliding Scale fee schedules, OAA would need to write the Insurance

> Commissioner.

>

> The response will take at least 1 month.)

>

>

>

> Here is the info, see the examples below. (No laws/codes were cited.)

>

> a-Payment ahead for specific services is not conducting insurance.

>

> b-Giving the client a discount for paying ahead for specific services

> is not conducting insurance.

>

> c-It is considered conducting insurance if the provider promises to

> cover " uncertain needs or costs " for a certain time period, ie

> " bearing the risk " for the client.

>

>

>

> Examples:

>

> Situation a- You offer a stop smoking series of 4 treatments for $200,

> and they pay the $200 at the first visit. You are not conducting

> insurance.

>

> Situation b- The patient will do a 5-treatment series to treat their

> back pain. Each treatment costs $60. You accept $260 for the 5

> treatments, if they pay the $260 at the 1st treatment (or ahead of

> time.) You are not conducting insurance.

>

> Situation c- The client pays $200 and the provider promises to cover

> anything they need during the 2 week time period when they are

> quitting smoking. This provider is conducting insurance.

>

>

>

> Item " c " is interesting since an MD is currently offering patients to

> pay a lump sum for complete care for a year at a time.

>

> These arrangements are called " boutique " plans and the approach is

> being investigated as to whether this is " conducting insurance " and

> needs to be regulated as such.

>

>

> Nat's note-

>

> We spoke w/an atty on the issue of cash discount and recieved this

> impression from the atty:

>

> You must charge everyone the same fees. You can accept different

> amounts for payments if the rationale is " defense-able " , reasonable,

> and consistent. " All providers need to have one " fee schedule " , i.e.,

> charge everyone the same- insurance, private pay patients, etc.

>

> We'll have more explanation on this soon.

>

>

>

 

 

 

 

[Guest guest]

While it is up to each state to ultimately decide what is and what is not

here is an article written by an attorney who gives the reason why this is

not legal. Check it out. It is better to be safe than sorry.

 

http://www.acupuncturetoday.com/archives2000/feb/02schroeder.html

 

Later

Mike W. Bowser, L Ac

 

 

On 12/23/04 7:32 AM, " Anne Crowley " <blazing.valley wrote:

 

>

> Pam,

>

> Thanks for taking the time to offer this information. I know it's a

> state by state decision. The American Acupuncture Council asks if you

> accept prepays when you are renewing. Then I hear they defer back to

> the state insurance commission. If anyone knows the rules in Maryland,

> I'd like to know. On the discounts, yes, I had heard this a while ago.

> Charge everyone the same fee, whether they have insurance or not, and

> there will be patients that may qualify for a sliding scale or reduced

> fee based on income needs. It appears the attorney is saying your

> " payment received " vs. your fee has to be defensible, reasonable and

> consistent.

>

> Anne

>

> Pam Price wrote:

>

>> >

>> > Natalie has been in OAA for years and past president several

>> > times.Please note this information is specific for Oregon. Pam Price

>> >

>> > -

>> > Natalie Arndt

>> > AAArndt, Natalie

>> > Wednesday, December 22, 2004 7:48 PM

>> > conducting insurance & pre-payment of services

>> >

>> >

>> > FYI---

>> >

>> > Prepayment of Services

>> > Nat talked to someone at the Oregon Insurance Division (ie Insurance

>> > Commissioner) on 12-22-04 and asked whether pre-payment of services is

>> > considered conducting insurance and therefore would require a license

>> > to conduct insurance.

>> >

>> > (Note- regarding an official statement on Time of Service Discounts &

>> > Sliding Scale fee schedules, OAA would need to write the Insurance

>> > Commissioner.

>> >

>> > The response will take at least 1 month.)

>> >

>> >

>> >

>> > Here is the info, see the examples below. (No laws/codes were cited.)

>> >

>> > a-Payment ahead for specific services is not conducting insurance.

>> >

>> > b-Giving the client a discount for paying ahead for specific services

>> > is not conducting insurance.

>> >

>> > c-It is considered conducting insurance if the provider promises to

>> > cover " uncertain needs or costs " for a certain time period, ie

>> > " bearing the risk " for the client.

>> >

>> >

>> >

>> > Examples:

>> >

>> > Situation a- You offer a stop smoking series of 4 treatments for $200,

>> > and they pay the $200 at the first visit. You are not conducting

>> > insurance.

>> >

>> > Situation b- The patient will do a 5-treatment series to treat their

>> > back pain. Each treatment costs $60. You accept $260 for the 5

>> > treatments, if they pay the $260 at the 1st treatment (or ahead of

>> > time.) You are not conducting insurance.

>> >

>> > Situation c- The client pays $200 and the provider promises to cover

>> > anything they need during the 2 week time period when they are

>> > quitting smoking. This provider is conducting insurance.

>> >

>> >

>> >

>> > Item " c " is interesting since an MD is currently offering patients to

>> > pay a lump sum for complete care for a year at a time.

>> >

>> > These arrangements are called " boutique " plans and the approach is

>> > being investigated as to whether this is " conducting insurance " and

>> > needs to be regulated as such.

>> >

>> >

>> > Nat's note-

>> >

>> > We spoke w/an atty on the issue of cash discount and recieved this

>> > impression from the atty:

>> >

>> > You must charge everyone the same fees. You can accept different

>> > amounts for payments if the rationale is " defense-able " , reasonable,

>> > and consistent. " All providers need to have one " fee schedule " , i.e.,

>> > charge everyone the same- insurance, private pay patients, etc.

>> >

>> > We'll have more explanation on this soon.

[Guest guest]

Mike:

 

Thanks for the link to the Acupuncture Today article. It was very

informative. I do know two acupuncturists, one from Maine, the other

Maryland who called the Amercian Acupuncture Council recently about

this. Their response was to defer to the state insurance commission as

you say. The article was written in 2000, so I would guess this

deferral to the state insurannce commission is their current answer, and

would determine whether it is legal or not for that state. The article

does point out other professionals that are using it, such as dentists.

 

Anne

 

mike Bowser wrote:

 

>

> While it is up to each state to ultimately decide what is and what is not

> here is an article written by an attorney who gives the reason why this is

> not legal. Check it out. It is better to be safe than sorry.

>

> http://www.acupuncturetoday.com/archives2000/feb/02schroeder.html

>

> Later

> Mike W. Bowser, L Ac

>

>

[Guest guest]

Dentists do not, the article mentioned an orthodontist under a specifc

example. The attorney warns us against using the pay for so many treatments

and get a discount. He gives good reasons why and also informs us to get a

legal opinion from the state insurance commissioners office. Makes good

sense to me although I would not engage in this as it seems shady just the

same. Why risk it? Later

Mike W. Bowser, L Ac

 

>Anne Crowley <blazing.valley

>Chinese Medicine

>Chinese Medicine

>Re: conducting insurance & pre-payment of services

>Fri, 24 Dec 2004 12:56:50 -0500

>

>

>Mike:

>

>Thanks for the link to the Acupuncture Today article. It was very

>informative. I do know two acupuncturists, one from Maine, the other

>Maryland who called the Amercian Acupuncture Council recently about

>this. Their response was to defer to the state insurance commission as

>you say. The article was written in 2000, so I would guess this

>deferral to the state insurannce commission is their current answer, and

>would determine whether it is legal or not for that state. The article

>does point out other professionals that are using it, such as dentists.

>

>Anne

>

>mike Bowser wrote:

>

> >

> > While it is up to each state to ultimately decide what is and what is

>not

> > here is an article written by an attorney who gives the reason why this

>is

> > not legal. Check it out. It is better to be safe than sorry.

> >

> > http://www.acupuncturetoday.com/archives2000/feb/02schroeder.html

> >

> > Later

> > Mike W. Bowser, L Ac

> >

> >

>

>

>

>

>

>