Guest guest Posted March 28, 2007 Report Share Posted March 28, 2007 Mike, Thanks for the info and especially for giving access to the source of the info. So many claims are made without any source so it's difficult to know what to take seriously. Following your advice...very interesting section: Section 17. Agents No individual may apply, procure, negotiate or place for others any policy or contract of a prepaid limited health service organization unless that individual holds a license or is otherwise authorized to sell accident and health insurance policies, health, hospital or medical service contracts, or health maintenance organization contracts. Unless I'm misreading this, it seems to close the door on most of us...or provide the key to how to do this legally if so desired... Stephen Woodley LAc Mike Bowser wrote: Actually you are wrong but it depends upon your state's insurance commissioner to prosecute. You might want to check out the NAIC (National Association of Insurance Commissioners) report on prepaid health plans as being the act of insurance. Insurance is about accepting a risk, which is what you are doing when you accept extra money for a future patient loss. Medicine (yes we practice medicine) in this country has never conducted itself with prepayments, it has always been at time of service or later. Insurance accepts loss. You will be hard pressed to prove that all patients need the same amount of prepaid care or for that matter that they need the amount that you are selling them.Mike W. Bowser, L Ac -- http://www.fastmail.fm - Access your email from home and the web Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 29, 2007 Report Share Posted March 29, 2007 I may be off-base here, but isn't it insurance if you say 'pre-pay $X, and I guarantee to treat you as many times as needed within a year' - I 'win' if you don't need it, you 'win' if you need more than $X amount? (called capitation) Is it insurance if you say 'pre-pay $X for 10 treatments, to be used as needed however long that takes'? karen stephen woodley wrote: > Mike, > Thanks for the info and especially for giving access to the source of > the info. So many claims are made without any source so it's difficult > to know what to take seriously. > Following your advice...very interesting section: > > Section 17. Agents > > No individual may apply, procure, negotiate or place for others any > policy or contract of a prepaid limited health service organization > unless that individual holds a license or is otherwise authorized to > sell accident and health insurance policies, health, hospital or medical > service contracts, or health maintenance organization contracts. > > Unless I'm misreading this, it seems to close the door on most of > us...or provide the key to how to do this legally if so desired... > > Stephen Woodley LAc > > Mike Bowser wrote: > Actually you are wrong but it depends upon your state's insurance > commissioner to prosecute. You might want to check out the NAIC > (National Association > of Insurance Commissioners) report on prepaid health plans as being > the act > of insurance. Insurance is about accepting a risk, which is what you > are > doing when you accept extra money for a future patient loss. Medicine > (yes we > practice medicine) in this country has never conducted itself with > prepayments, it > has always been at time of service or later. Insurance accepts loss. > > You will be hard pressed to prove that all patients need the same > amount > of prepaid care or for that matter that they need the amount that you > are selling > them.Mike W. Bowser, L Ac > > -- > http://www.fastmail.fm <http://www.fastmail.fm> - Access your email > from home and the web > > > >------ > > > >Version: 7.5.446 / Virus Database: 268.18.20/737 - Release 28/03/2007 16:23 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 29, 2007 Report Share Posted March 29, 2007 Great article in previous issue of Acupuncturetoday about this issue written by an attorney. You will have to search for issue, not sure which one it is. By the way, as I understand this, Karen you are correct. Mike W. Bowser, L Ac : tryfan: Thu, 29 Mar 2007 07:10:20 -0500Re: side issue pre-paid plans I may be off-base here, but isn't it insurance if you say 'pre-pay $X, and I guarantee to treat you as many times as needed within a year' - I 'win' if you don't need it, you 'win' if you need more than $X amount? (called capitation) Is it insurance if you say 'pre-pay $X for 10 treatments, to be used as needed however long that takes'?karenstephen woodley wrote:> Mike,> Thanks for the info and especially for giving access to the source of> the info. So many claims are made without any source so it's difficult> to know what to take seriously.> Following your advice...very interesting section:>> Section 17. Agents>> No individual may apply, procure, negotiate or place for others any> policy or contract of a prepaid limited health service organization> unless that individual holds a license or is otherwise authorized to> sell accident and health insurance policies, health, hospital or medical> service contracts, or health maintenance organization contracts.>> Unless I'm misreading this, it seems to close the door on most of> us...or provide the key to how to do this legally if so desired...>> Stephen Woodley LAc>> Mike Bowser wrote:> Actually you are wrong but it depends upon your state's insurance> commissioner to prosecute. You might want to check out the NAIC> (National Association> of Insurance Commissioners) report on prepaid health plans as being> the act> of insurance. Insurance is about accepting a risk, which is what you> are> doing when you accept extra money for a future patient loss. Medicine> (yes we> practice medicine) in this country has never conducted itself with> prepayments, it> has always been at time of service or later. Insurance accepts loss.>> You will be hard pressed to prove that all patients need the same> amount> of prepaid care or for that matter that they need the amount that you> are selling> them.Mike W. Bowser, L Ac>> -- > http://www.fastmail.fm <http://www.fastmail.fm> - Access your email > from home and the web>> >>------------------------->>No virus found in this incoming message.>>Version: 7.5.446 / Virus Database: 268.18.20/737 - Release 28/03/2007 16:23> >[Non-text portions of this message have been removed] _______________ Take a break and play crossword puzzles - FREE! http://games.msn.com/en/flexicon/default.htm?icid=flexicon_ wlmemailtaglinemarch07 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 29, 2007 Report Share Posted March 29, 2007 Several of the area massage thearapists offer massage packages: buy a package of 6 massages for $240 when regular price is $60 each. This helps their clients get more regular massages while saving some money. This is done by individual therapists, spas, and an area " health and wellness center " associated with a hospital. Most of our massage clients (both our acupuncture assistants are CMTs and do regular body work at our clinic outside of TCM hours) prefer to prepay for massages, even if it is immediately prior to the massage. No buzz-kill check-writing right after 60 minutes of heaven. Additionally, PAYG parents of driving-age children often prepay (at the time of their own treatment) for the next treatment of Junior who will be treated later that day/week Are the above examples of " selling insurance without a license? " Of course not! A prepaid card good for 10 carwashes is NOT insurance against having a dirty car. Accepting prepayment for specific defined services to be executed at a pre-agreed schedule, with refunds given for unused services is rather different from what insurers do. The liability I take on by accepting prepayment is FIXED--for each treatment prepaid we are obligated to provide ONE TREATMENT. The area's largest independant insurance guy is a client (low back pain...was in a wheelchair when he first showed up), and he is fully aware of our policies and procedures. We have had brief conversations with regardwhat it would take to create an insurance system specifically to cover treatments/therapies by alternative health care providers NOT covered by most traditional insurances. While I have not directly solicited his opinion regarding our present situation, he has not voiced a single word of concern/warning/whatever. Mark Z Stephen wrote: > No individual may apply, procure, negotiate or place for others any > policy or contract of a prepaid limited health service organization >> unless that individual holds a license or is otherwise authorized to >> sell accident and health insurance policies, health, hospital or medical > > service contracts, or health maintenance organization contracts. > > The prepaid " contract " for specific health services at our clinic is arranged by the individual desiring those services and the service provider, not " applied, procured, negotiated or placed for others " by any " individual " and is not for a " limited health service organization " If I could get reimbursed for premiums paid against which I made no claim, then I could only " win " the bet, and the insurer could only lose or break even. Obviously there would be no industry there. With our process, only the client wins in that they buy a package of services at a reduced price (thru " bookkeeping savings " ) which are delivered at a specific schedule. Prepayment also saves the client time at every treatment (no waiting at the desk to pay ang get a receipt). Should the client change their mind the unused portion of the package is refunded in such a way that the amount they paid for services used is what they would have paid without benefit of prepayment. Those who have recieved refunds for any reason have been perfectly satisfied with this predivulged refund policy. We offer savings because prepayment saves US time both at our front desk (which turns into saved time for all our clients) and actual bookkeeping time (one entry rather than 33 or 57 or 12). Chinese Medicine , karen <tryfan wrote: > > I may be off-base here, but isn't it insurance if you say 'pre-pay $X, > and I guarantee to treat you as many times as needed within a year' - I > 'win' if you don't need it, you 'win' if you need more than $X amount? > (called capitation) Is it insurance if you say 'pre-pay $X for 10 > treatments, to be used as needed however long that takes'? > karen > > stephen woodley wrote: > > > Mike, > > Thanks for the info and especially for giving access to the source of > > the info. So many claims are made without any source so it's difficult > > to know what to take seriously. > > Following your advice...very interesting section: > > > > Section 17. Agents > > > > No individual may apply, procure, negotiate or place for others any > > policy or contract of a prepaid limited health service organization > > unless that individual holds a license or is otherwise authorized to > > sell accident and health insurance policies, health, hospital or medical > > service contracts, or health maintenance organization contracts. > > > > Unless I'm misreading this, it seems to close the door on most of > > us...or provide the key to how to do this legally if so desired... > > > > Stephen Woodley LAc > > > > Mike Bowser wrote: > > Actually you are wrong but it depends upon your state's insurance > > commissioner to prosecute. You might want to check out the NAIC > > (National Association > > of Insurance Commissioners) report on prepaid health plans as being > > the act > > of insurance. Insurance is about accepting a risk, which is what you > > are > > doing when you accept extra money for a future patient loss. Medicine > > (yes we > > practice medicine) in this country has never conducted itself with > > prepayments, it > > has always been at time of service or later. Insurance accepts loss. > > > > You will be hard pressed to prove that all patients need the same > > amount > > of prepaid care or for that matter that they need the amount that you > > are selling > > them.Mike W. Bowser, L Ac > > > > -- > > http://www.fastmail.fm <http://www.fastmail.fm> - Access your email > > from home and the web > > > > > > > >- ----- > > > > > > > >Version: 7.5.446 / Virus Database: 268.18.20/737 - Release Date: 28/03/2007 16:23 > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 30, 2007 Report Share Posted March 30, 2007 Mark, Actually whenever a patient pays for services they did NOT receive, it is a form of insurance even if they intend to send in their child later in the week. I am not sure why we continue to disbelieve this and want to try to justify what massage therapists do as equal to what we do. They are two completely different things and are ruled by differing sets of laws. We are medical providers and are licensed in many states as providing a medical service, massage therapists/cosmetologists are not. As such we need to obey the way business is conducted within this scenario. Please seek an attorney for further clarification of the laws. Mike W. Bowser, L Ac : zaranski: Thu, 29 Mar 2007 18:36:17 +0000Re: side issue pre-paid plans Several of the area massage thearapists offer massage packages: buy a package of 6 massages for $240 when regular price is $60 each. This helps their clients get more regular massages while saving some money. This is done by individual therapists, spas, and an area " health and wellness center " associated with a hospital.Most of our massage clients (both our acupuncture assistants are CMTs and do regular body work at our clinic outside of TCM hours) prefer to prepay for massages, even if it is immediately prior to the massage. No buzz-kill check-writing right after 60 minutes of heaven.Additionally, PAYG parents of driving-age children often prepay (at the time of their own treatment) for the next treatment of Junior who will be treated later that day/weekAre the above examples of " selling insurance without a license? " Of course not! A prepaid card good for 10 carwashes is NOT insurance against having a dirty car.Accepting prepayment for specific defined services to be executed at a pre-agreed schedule, with refunds given for unused services is rather different from what insurers do. The liability I take on by accepting prepayment is FIXED--for each treatment prepaid we are obligated to provide ONE TREATMENT.The area's largest independant insurance guy is a client (low back pain...was in a wheelchair when he first showed up), and he is fully aware of our policies and procedures. We have had brief conversations with regardwhat it would take to create an insurance system specifically to cover treatments/therapies by alternative health care providers NOT covered by most traditional insurances. While I have not directly solicited his opinion regarding our present situation, he has not voiced a single word of concern/warning/whatever.Mark ZStephen wrote:> No individual may apply, procure, negotiate or place for others any> policy or contract of a prepaid limited health service organization>> unless that individual holds a license or is otherwise authorized to>> sell accident and health insurance policies, health, hospital or medical> > service contracts, or health maintenance organization contracts.> >The prepaid " contract " for specific health services at our clinic is arranged by the individual desiring those services and the service provider, not " applied, procured, negotiated or placed for others " by any " individual " and is not for a " limited health service organization " If I could get reimbursed for premiums paid against which I made no claim, then I could only " win " the bet, and the insurer could only lose or break even. Obviously there would be no industry there. With our process, only the client wins in that they buy a package of services at a reduced price (thru " bookkeeping savings " ) which are delivered at a specific schedule. Prepayment also saves the client time at every treatment (no waiting at the desk to pay ang get a receipt).Should the client change their mind the unused portion of the package is refunded in such a way that the amount they paid for services used is what they would have paid without benefit of prepayment. Those who have recieved refunds for any reason have been perfectly satisfied with this predivulged refund policy.We offer savings because prepayment saves US time both at our front desk (which turns into saved time for all our clients) and actual bookkeeping time (one entry rather than 33 or 57 or 12).--- In Chinese Medicine , karen <tryfan wrote:>> I may be off-base here, but isn't it insurance if you say 'pre-pay $X, > and I guarantee to treat you as many times as needed within a year' - I > 'win' if you don't need it, you 'win' if you need more than $X amount? > (called capitation) Is it insurance if you say 'pre-pay $X for 10 > treatments, to be used as needed however long that takes'?> karen> > stephen woodley wrote:> > > Mike,> > Thanks for the info and especially for giving access to the source of> > the info. So many claims are made without any source so it's difficult> > to know what to take seriously.> > Following your advice...very interesting section:> >> > Section 17. Agents> >> > No individual may apply, procure, negotiate or place for others any> > policy or contract of a prepaid limited health service organization> > unless that individual holds a license or is otherwise authorized to> > sell accident and health insurance policies, health, hospital or medical> > service contracts, or health maintenance organization contracts.> >> > Unless I'm misreading this, it seems to close the door on most of> > us...or provide the key to how to do this legally if so desired...> >> > Stephen Woodley LAc> >> > Mike Bowser wrote:> > Actually you are wrong but it depends upon your state's insurance> > commissioner to prosecute. You might want to check out the NAIC> > (National Association> > of Insurance Commissioners) report on prepaid health plans as being> > the act> > of insurance. Insurance is about accepting a risk, which is what you> > are> > doing when you accept extra money for a future patient loss. Medicine> > (yes we> > practice medicine) in this country has never conducted itself with> > prepayments, it> > has always been at time of service or later. Insurance accepts loss.> >> > You will be hard pressed to prove that all patients need the same> > amount> > of prepaid care or for that matter that they need the amount that you> > are selling> > them.Mike W. Bowser, L Ac> >> > -- > > http://www.fastmail.fm <http://www.fastmail.fm> - Access your email > > from home and the web> >> > > >> >------------------------------> >> >No virus found in this incoming message.> >> >Version: 7.5.446 / Virus Database: 268.18.20/737 - Release 28/03/2007 16:23> > > >> > > Quote Link to comment Share on other sites More sharing options...
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