ASHN fee for service info

[Guest guest]

Hi Everyone,

A while back I spoke with some members who had decided to accept this network and become providers. The pay was listed as $37 per appointment. There was some confusion that if you lose money on one part of the network, you'll make it up on another area that pays more. I've now spent one hour on the phone and called 1-800-6789-9133, 1-800-972-4266, 503-216-6595, 503-215-6389, 877-707-2746, and finally got someone who is listed as the director of network provider relations. A guy named Donahue. He's supposed to call me soon with exact details. I spoke with several reps from ASHN, Providence EPO and Providence PPO and everyone said there was NO OTHER PAYMENT THEY KNEW OF OTHER THAN THE $37 per visit. Also the payment is listed as "all inclusive". This was explained to me to mean that under NO CIRCUMSTANCES CAN WE BILL THE PATIENT FOR ANYTHING OTHER THAN massage. And even then we can only bill for it if we use more than 15 min increments. The policy is sold as "all inclusive" Signing that contract means just that. There is a 5 visit limit per year. However, if you want more, you can fill out a 2 page questionaire to request more. There is a form to fill out for 'continuation' of care that will allow more than 1 treatment per form. It's reviewed by someone and they decide if you get more or have to do more paperwork to get the right to continue beyond that. I'll let you know what I find out when Donahue calls me.

Minga Guerrero DC

Portland, OR

[Guest guest]

A relatively simple way to figure out if you can afford to participate in any MCO:

Get a reliable average monthly figure for your total cash operating expenses exclusive of Doctor's compensation. Divide this number by your average number of all patients/month. Use a trailing 12 month average. This gives you your cost of providing care per patient visit. this represents a minimum cost, as it does not usually take into account non-cash costs like depreciation and amortization, or long term liabilities, such as loan principal repayments.

It also doesn't take into account the intangible positives, like future referrals and service concepts.

Call or e-mail if you want to discuss on an individual basis.

Roy

--

Roy Steinberg DC DABCO

Steinberg Consulting Services Inc.

14136 NE 32nd Place

Bellevue WA 98007

425-883-8783: voice

425-556-0616: fax

From: " Joyce McClure, D.C. " <dr-j@...>

Date: Thu, 12 Dec 2002 20:24:47 -0800

AboWoman@..., , " DRBOB " <drbob@...>, " Lonnie " <lonniemily@...>

Subject: Re: ASHN fee for service info

Lonnie,

I think there may be many of us who feel as you do. I find myself in the same position. It is probably true that I could cut my practice by charging much higher fees thereby working less to make the same $$. (Nod to you, Dr. Bob!) On the other hand, I do believe in chiropractic as both an efficacious treatment for what ails human beings as well as a more healthy lifestyle choice with respect to healing and living. I want to offer the exposure of our care/philosophy to a broad base of patients, not just those wealthy enough to have " good " insurance or the ability to pay out of pocket or the misfortune of injury claims. There are other insurances out there who reimburse at an even lower rate by the time payment is adjusted for " shared risk " and " allowed amount " , as we all know. And this is not just CHP.

Paperwork sucks. I think we all agree. At least ASHN now allows us the " five free " visits per calendar year. I have found ASHN on the whole to be reasonable in terms of allowable number of visits per request. If I have a problem with their response to my claim, within 24 hours I can speak with the reviewing doctor and usually the problem is resolved. It does cause me to focus more on a treatment plan, which is probably a good thing. It somewhat forces the doctor to help the patient share responsibilty for their healing process (are they doing exercises? Have you discussed ergonomics? etc.) After you've done the forms a few hundred times, they get much easier:>) I gather it is now possible to submit these on-line. (I haven't tried this yet- has anyone else?)

Given the extra amount of time/work vs. other payors, it is NOT really an appropriate amount of reimbursement. I suspect that things will sort themselves out and there will be those who continue to serve these patients and those who won't- just like now. Maybe this will be a great thing to have WSCC interns involved in...

Joyce

ASHN fee for service info

Hi Everyone,

A while back I spoke with some members who had decided to accept this network and become providers. The pay was listed as $37 per appointment. There was some confusion that if you lose money on one part of the network, you'll make it up on another area that pays more. I've now spent one hour on the phone and called 1-800-6789-9133, 1-800-972-4266, 503-216-6595, 503-215-6389, 877-707-2746, and finally got someone who is listed as the director of network provider relations. A guy named Donahue. He's supposed to call me soon with exact details. I spoke with several reps from ASHN, Providence EPO and Providence PPO and everyone said there was NO OTHER PAYMENT THEY KNEW OF OTHER THAN THE $37 per visit. Also the payment is listed as " all inclusive " . This was explained to me to mean that under NO CIRCUMSTANCES CAN WE BILL THE PATIENT FOR ANYTHING OTHER THAN massage. And even then we can only bill for it if we use more than 15 min increments. The policy is sold as! " all inclusive " Signing that contract means just that. There is a 5 visit limit per year. However, if you want more, you can fill out a 2 page questionaire to request more. There is a form to fill out for 'continuation' of care that will allow more than 1 treatment per form. It's reviewed by someone and they decide if you get more or have to do more paperwork to get the right to continue beyond that. I'll let you know what I find out when Donahue calls me.

Minga Guerrero DC

Portland, OR

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