Guest guest Posted August 20, 2008 Report Share Posted August 20, 2008 according to robert, sliding scale is discriminatory against those making a higher wage, therefore illegal. we cannot charge different rates based on income. what we can do is offer a low rate that is available to everyone. you cannot work out any kind of a side deal with one or a small group of patients for a lower rate. again, discriminatory against the rest of the patients not in on the deal. (no different then giving a discount to blacks only, whites only, men only, etc.). kath On Tue, Aug 19, 2008 at 7:02 PM, Emmanuel Segmen <mrsegmenwrote: > Kath, > > Someone offlist asked me to address this as an issue of legal ethics rather > than insurance policy or insurance fraud. > > Consider the notion of charging a practitioner fee that is purely a > calculation of your patient's own hourly, weekly, monthly or annual income. > This could be one of multiple criteria to be negotiated at the outset of > treatment. This overcomes the subjective considerations of a sliding scale. > This would also overcome the objections of acting in a subjectively > prejudiced manner. > > Another legal-ethics issue of discounts in any business setting has to do > with unfair competition between corporate and small business. I'm guessing > that is not what Robert. K. was addressing. > > Respectfully, > > Emmanuel Segmen > - > > Hi Kath, > > The issue as you have stated it (or interpreted it from Robert K.) may be > factual to some degree as it relates to corporate insurance and the > healthcare insurance setting. If in fact you were working exclusively in > that setting, you would not be able to see patients from outside that > setting nor could you refer patients to anyone outside that setting. > However, even MD orthopedic surgeons here in the San Francisco Bay area are > generally outside of this configuration unless they are employed by Kaiser. > For instance the orthopedic surgeons at Alta Bates Hospital on Ashby in > Berkeley may decline patients who do not have insurance or do not qualify > for Medi-Cal. Alternatively they can accept such patients and perform > procedures inside their own office or outside of Alta Bates Hospital campus > at a private surgery on Telegraph Avenue. The costs can be profoundly > different. There are some very altruistic practitioners around here. > > The healthcare providers can not buck the pricing system within the > insurance framework when doing work inside that framework. The > administration at the hospital has mechanisms for waiving fees, but this is > not in the hands of the individual practitioner who is working in essence as > an independent contractor and receiving payment via a 3rd party. > > So you only get into trouble if you treat and charge patients with > healthcare insurance in a manner that is out of line with the policies of > the insurer, and then file an insurance claim for your own or for their > compensation. Don't confuse this with performing services completely outside > of the corporate insurance framework. You are then only subject to the laws > of your own profession and the professional practices within the > jurisdiction of your license. You would not then be engaged in corporate 3rd > party payment practices or the rules that regulate such practices. You could > charge as much or as little as you decide if you acted outside of the > insurance setting. > > Likewise you could get your car fixed for a reasonable price from a private > licensed mechanic. However, if you then file an insurance claim and get an > insurance settlement that's larger than what you paid, you may be engaged in > fraud. So you have to decide whether to act within the insurance system or > completely outside of it. > > Respectfully, > > Emmanuel Segmen > ___________________ > Kath Bartlett wrote: > Mon Aug 18, 2008 6:50 pm (PDT) > I had an interesting conversation with Robert Kientz who teaches the NCCAOM > Ethics class about giving discounts. (Robert Keintz, btw, is the former > pres & dean of curriculum at the phoenix college of acu. he was also an > instrumental player in writing the practice act when AZ obtained > licensure). > > On the issue of giving patients discounts: basically we cannot do this. > commonly discounts are offered to a select group of people: eg. medicaid > patients, seniors, students, your favorite club, blue cross patients, > sliding scale. the reason we can't do this is that it's considered > discriminatory against those who don't fall into the select group > (regardless of whether or not it's offered for altruist reasons). this is a > mestemeaner (sp?) offense. if insurance is involved so that insurance > patients don't qualify for the discount (thus billing the insur co a higher > rate than the cash patient), it becomes a felony. (a time of service > discount would be ok, so long as everyone who pay at the time of service > gets it, and its a reasonable discount: 25%). > > this means that the sliding scale fees offered by community acupuncture > clinics and others are illegal. you have to set one flat rate that applies > to everyone. > > you can offer a coupon for x amount off, so long as everyone is informed > about the offer so that they may all take advantage of the discount. ($10 > off the initial visit in September. you have to offer it to all new > patients). you can offer a discount on a particular day or time: monday > mornings are 10% off. again, you have to offer it to all your patients. if > you want to offer a lower price to a particular population, you need a > separate location: $45tx at x,y, z clinic. again, anyone who comes to that > location gets the $45 tx. you would need to be able to show that the lower > overhead at location B enables you to offer the tx at the lower rate: the > location across town is a bare bones setting in a low rent district, > with fewer amenities and staffing needs. > > another commonly used but illegal practice is pkg tx: get 10 tx for $500, > this would normally be $700, and paid in adv gift certificates. the reason > is accepting payment in adv of service constitutes insurance, and only > insurance cos are licensed to do this. so a patient cannot pay on monday > for the tx s/he will receive on friday. payment must be made after the tx > is received, not prior to. > > complaints about these practices would be directed to the state atty > generals office, the lic. boards, state orgs and nccaom. > > -- > > Oriental Medicine > Experienced, Dedicated, Effective > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2008 Report Share Posted August 20, 2008 It is very legal to charge on a sliding scale. It is nothing like charging based on race or gender. wrote: > according to robert, sliding scale is discriminatory against those making a > higher wage, therefore illegal. we cannot charge different rates based on > income. what we can do is offer a low rate that is available to everyone. > you cannot work out any kind of a side deal with one or a small group of > patients for a lower rate. again, discriminatory against the rest of the > patients not in on the deal. (no different then giving a discount to blacks > only, whites only, men only, etc.). > kath > On Tue, Aug 19, 2008 at 7:02 PM, Emmanuel Segmen < mrsegmen (AT) comcast (DOT) net >wrote: >> Kath, >> >> Someone offlist asked me to address this as an issue of legal ethics rather >> than insurance policy or insurance fraud. >> >> Consider the notion of charging a practitioner fee that is purely a >> calculation of your patient's own hourly, weekly, monthly or annual income. >> This could be one of multiple criteria to be negotiated at the outset of >> treatment. This overcomes the subjective considerations of a sliding scale. >> This would also overcome the objections of acting in a subjectively >> prejudiced manner. >> >> Another legal-ethics issue of discounts in any business setting has to do >> with unfair competition between corporate and small business. I'm guessing >> that is not what Robert. K. was addressing. >> >> Respectfully, >> >> Emmanuel Segmen >> - >> >> Hi Kath, >> >> The issue as you have stated it (or interpreted it from Robert K.) may be >> factual to some degree as it relates to corporate insurance and the >> healthcare insurance setting. If in fact you were working exclusively in >> that setting, you would not be able to see patients from outside that >> setting nor could you refer patients to anyone outside that setting. >> However, even MD orthopedic surgeons here in the San Francisco Bay area are >> generally outside of this configuration unless they are employed by Kaiser. >> For instance the orthopedic surgeons at Alta Bates Hospital on Ashby in >> Berkeley may decline patients who do not have insurance or do not qualify >> for Medi-Cal. Alternatively they can accept such patients and perform >> procedures inside their own office or outside of Alta Bates Hospital campus >> at a private surgery on Telegraph Avenue. The costs can be profoundly >> different. There are some very altruistic practitioners around here. >> >> The healthcare providers can not buck the pricing system within the >> insurance framework when doing work inside that framework. The >> administration at the hospital has mechanisms for waiving fees, but this is >> not in the hands of the individual practitioner who is working in essence as >> an independent contractor and receiving payment via a 3rd party. >> >> So you only get into trouble if you treat and charge patients with >> healthcare insurance in a manner that is out of line with the policies of >> the insurer, and then file an insurance claim for your own or for their >> compensation. Don't confuse this with performing services completely outside >> of the corporate insurance framework. You are then only subject to the laws >> of your own profession and the professional practices within the >> jurisdiction of your license. You would not then be engaged in corporate 3rd >> party payment practices or the rules that regulate such practices. You could >> charge as much or as little as you decide if you acted outside of the >> insurance setting. >> >> Likewise you could get your car fixed for a reasonable price from a private >> licensed mechanic. However, if you then file an insurance claim and get an >> insurance settlement that's larger than what you paid, you may be engaged in >> fraud. So you have to decide whether to act within the insurance system or >> completely outside of it. >> >> Respectfully, >> >> Emmanuel Segmen >> ____________ _______ >> Kath Bartlett wrote: >> Mon Aug 18, 2008 6:50 pm (PDT) >> I had an interesting conversation with Robert Kientz who teaches the NCCAOM >> Ethics class about giving discounts. (Robert Keintz, btw, is the former >> pres & dean of curriculum at the phoenix college of acu. he was also an >> instrumental player in writing the practice act when AZ obtained >> licensure). >> >> On the issue of giving patients discounts: basically we cannot do this. >> commonly discounts are offered to a select group of people: eg. medicaid >> patients, seniors, students, your favorite club, blue cross patients, >> sliding scale. the reason we can't do this is that it's considered >> discriminatory against those who don't fall into the select group >> (regardless of whether or not it's offered for altruist reasons). this is a >> mestemeaner (sp?) offense. if insurance is involved so that insurance >> patients don't qualify for the discount (thus billing the insur co a higher >> rate than the cash patient), it becomes a felony. (a time of service >> discount would be ok, so long as everyone who pay at the time of service >> gets it, and its a reasonable discount: 25%). >> >> this means that the sliding scale fees offered by community acupuncture >> clinics and others are illegal. you have to set one flat rate that applies >> to everyone. >> >> you can offer a coupon for x amount off, so long as everyone is informed >> about the offer so that they may all take advantage of the discount. ($10 >> off the initial visit in September. you have to offer it to all new >> patients). you can offer a discount on a particular day or time: monday >> mornings are 10% off. again, you have to offer it to all your patients. if >> you want to offer a lower price to a particular population, you need a >> separate location: $45tx at x,y, z clinic. again, anyone who comes to that >> location gets the $45 tx. you would need to be able to show that the lower >> overhead at location B enables you to offer the tx at the lower rate: the >> location across town is a bare bones setting in a low rent district, >> with fewer amenities and staffing needs. >> >> another commonly used but illegal practice is pkg tx: get 10 tx for $500, >> this would normally be $700, and paid in adv gift certificates. the reason >> is accepting payment in adv of service constitutes insurance, and only >> insurance cos are licensed to do this. so a patient cannot pay on monday >> for the tx s/he will receive on friday. payment must be made after the tx >> is received, not prior to. >> >> complaints about these practices would be directed to the state atty >> generals office, the lic. boards, state orgs and nccaom. >> >> -- >> >> Oriental Medicine >> Experienced, Dedicated, Effective >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 20, 2008 Report Share Posted August 20, 2008 Sliding scale clinics, at least those involved with CAN do not base on income, it is available to anyone. Just to get the facts clear. On Wed, Aug 20, 2008 at 12:25 PM, J. Lynn Detamore <lynndetamorewrote: > It is very legal to charge on a sliding scale. It is nothing like > charging based on race or gender. > > > wrote: > > according to robert, sliding scale is discriminatory against those making > a > > higher wage, therefore illegal. we cannot charge different rates based on > > > income. what we can do is offer a low rate that is available to everyone. > > > you cannot work out any kind of a side deal with one or a small group of > > patients for a lower rate. again, discriminatory against the rest of the > > patients not in on the deal. (no different then giving a discount to > blacks > > only, whites only, men only, etc.). > > kath > > On Tue, Aug 19, 2008 at 7:02 PM, Emmanuel Segmen < mrsegmen (AT) comcast (DOT) net > >wrote: > >> Kath, > >> > >> Someone offlist asked me to address this as an issue of legal ethics > rather > >> than insurance policy or insurance fraud. > >> > >> Consider the notion of charging a practitioner fee that is purely a > >> calculation of your patient's own hourly, weekly, monthly or annual > income. > >> This could be one of multiple criteria to be negotiated at the outset of > > >> treatment. This overcomes the subjective considerations of a sliding > scale. > >> This would also overcome the objections of acting in a subjectively > >> prejudiced manner. > >> > >> Another legal-ethics issue of discounts in any business setting has to > do > >> with unfair competition between corporate and small business. I'm > guessing > >> that is not what Robert. K. was addressing. > >> > >> Respectfully, > >> > >> Emmanuel Segmen > >> - > >> > >> Hi Kath, > >> > >> The issue as you have stated it (or interpreted it from Robert K.) may > be > >> factual to some degree as it relates to corporate insurance and the > >> healthcare insurance setting. If in fact you were working exclusively in > > >> that setting, you would not be able to see patients from outside that > >> setting nor could you refer patients to anyone outside that setting. > >> However, even MD orthopedic surgeons here in the San Francisco Bay area > are > >> generally outside of this configuration unless they are employed by > Kaiser. > >> For instance the orthopedic surgeons at Alta Bates Hospital on Ashby in > >> Berkeley may decline patients who do not have insurance or do not > qualify > >> for Medi-Cal. Alternatively they can accept such patients and perform > >> procedures inside their own office or outside of Alta Bates Hospital > campus > >> at a private surgery on Telegraph Avenue. The costs can be profoundly > >> different. There are some very altruistic practitioners around here. > >> > >> The healthcare providers can not buck the pricing system within the > >> insurance framework when doing work inside that framework. The > >> administration at the hospital has mechanisms for waiving fees, but this > is > >> not in the hands of the individual practitioner who is working in > essence as > >> an independent contractor and receiving payment via a 3rd party. > >> > >> So you only get into trouble if you treat and charge patients with > >> healthcare insurance in a manner that is out of line with the policies > of > >> the insurer, and then file an insurance claim for your own or for their > >> compensation. Don't confuse this with performing services completely > outside > >> of the corporate insurance framework. You are then only subject to the > laws > >> of your own profession and the professional practices within the > >> jurisdiction of your license. You would not then be engaged in corporate > 3rd > >> party payment practices or the rules that regulate such practices. You > could > >> charge as much or as little as you decide if you acted outside of the > >> insurance setting. > >> > >> Likewise you could get your car fixed for a reasonable price from a > private > >> licensed mechanic. However, if you then file an insurance claim and get > an > >> insurance settlement that's larger than what you paid, you may be > engaged in > >> fraud. So you have to decide whether to act within the insurance system > or > >> completely outside of it. > >> > >> Respectfully, > >> > >> Emmanuel Segmen > >> ____________ _______ > >> Kath Bartlett wrote: > >> Mon Aug 18, 2008 6:50 pm (PDT) > >> I had an interesting conversation with Robert Kientz who teaches the > NCCAOM > >> Ethics class about giving discounts. (Robert Keintz, btw, is the former > >> pres & dean of curriculum at the phoenix college of acu. he was also an > >> instrumental player in writing the practice act when AZ obtained > >> licensure). > >> > >> On the issue of giving patients discounts: basically we cannot do this. > >> commonly discounts are offered to a select group of people: eg. medicaid > > >> patients, seniors, students, your favorite club, blue cross patients, > >> sliding scale. the reason we can't do this is that it's considered > >> discriminatory against those who don't fall into the select group > >> (regardless of whether or not it's offered for altruist reasons). this > is a > >> mestemeaner (sp?) offense. if insurance is involved so that insurance > >> patients don't qualify for the discount (thus billing the insur co a > higher > >> rate than the cash patient), it becomes a felony. (a time of service > >> discount would be ok, so long as everyone who pay at the time of service > > >> gets it, and its a reasonable discount: 25%). > >> > >> this means that the sliding scale fees offered by community acupuncture > >> clinics and others are illegal. you have to set one flat rate that > applies > >> to everyone. > >> > >> you can offer a coupon for x amount off, so long as everyone is informed > > >> about the offer so that they may all take advantage of the discount. > ($10 > >> off the initial visit in September. you have to offer it to all new > >> patients). you can offer a discount on a particular day or time: monday > >> mornings are 10% off. again, you have to offer it to all your patients. > if > >> you want to offer a lower price to a particular population, you need a > >> separate location: $45tx at x,y, z clinic. again, anyone who comes to > that > >> location gets the $45 tx. you would need to be able to show that the > lower > >> overhead at location B enables you to offer the tx at the lower rate: > the > >> location across town is a bare bones setting in a low rent district, > >> with fewer amenities and staffing needs. > >> > >> another commonly used but illegal practice is pkg tx: get 10 tx for > $500, > >> this would normally be $700, and paid in adv gift certificates. the > reason > >> is accepting payment in adv of service constitutes insurance, and only > >> insurance cos are licensed to do this. so a patient cannot pay on monday > > >> for the tx s/he will receive on friday. payment must be made after the > tx > >> is received, not prior to. > >> > >> complaints about these practices would be directed to the state atty > >> generals office, the lic. boards, state orgs and nccaom. > >> > >> -- > >> > >> Oriental Medicine > >> Experienced, Dedicated, Effective > >> > >> Quote Link to comment Share on other sites More sharing options...
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