Treatment Discounts: sliding scales - Yes!

[Guest guest]

Charging on a sliding scale is completely legal. Legally, and insurance-wise,

the safest way to charge on a ss is per Federal poverty standards. This is a

pre-defined, legal standard. There is nothing illegal or unethical about

charging this way.

 

Here's the link to the US Poverty Ferederal Guidelines for the lower 48 states

and DC: 

 

http://www.dhhs.state.nh.us/NR/rdonlyres/er2mzvaifxbsufvb5yldhooqdz3mpsp7gcr5rlg\

br2ltagiquc5al374tbczp7nkouxqrnltbfvgt6zwqqltezoj6ff/Fed+Poverty+Guidelines+2008\

+Annual-Monthly.pdf

 

Here's the US Department of Education / Office of Postsecondary Education's

table of poverty guidelines that includes AK and HI, and the statement defining

poverty status:

 

http://www.ed.gov/about/offices/list/ope/trio/incomelevels.html

 

" The term " low-income individual " means an individual whose family's taxable

income for the preceding year did not exceed 150 percent of the poverty level

amount.

 

The figures shown under family income represent amounts equal to 150 percent of

the family income levels established by the Census Bureau for determining

poverty status. The poverty guidelines were published by the U.S. Department of

Health and Human Services in the Federal Register, Vol. 73, No. 15, January 23,

2008, pp. 3,971-3,972. "

 

You do *HAVE* to offer the same, exact, identical sliding scale discounts to

*All* insured patients as uninsured patients. To do otherwise, to only offer

sliding scale fees to uninsured patients, *IS* unequivocally insurance fraud.

Waiving patient deductibles or co-pays is just as fraudulent. Technically, in

insurance language, charging deductibles, co-pays and co-insurance is the

insurer's way of sharing risk [i.e., risk of expenses] with the insured, and it

is considered fraud for the provider to eliminate this shared risk by the

insured. Also, as others have pointed out, charging an insurance patient more

than you charge uninsured patients is also insurance fraud.

 

Of course, if we in the states were ever silly enough to get involved in

Medicare billing, we'll have other, more absurd troubles. I still recall

listening to an MD talk about how he was doing some pro bono patient care. After

years of running his business this way, he got a nasty letter from Medicare

demanding that he provide pro bono care to the same percentage of Medicare

patients as the percentage of non-Medicare patients being granted pro bono care

in his practice. Aaargh.

 

 

Pain is Normal - Be Weird!

 

J. Lynn Detamore, MS, L.Ac.

Licensed Acupuncturist

PO Box 14, Sheridan, OR 97378

503.474.8876

lynndetamore

 

~ Doing Better Than I Deserve ~