Re: NCBF

[Guest guest]

I have never sent any letters to insurance companies.  Twice I have gotten calls and ended up just leaving voicemail saying my noncovered benefits fee was not for administrative services and was specifically for services that insurance did not cover and I have never heard back.

Yes, fingers do remain crossed.

 

Does anyone have a non-covered benefit letter that the insurances accepted as not being in conflict with their contract?

[Guest guest]

I'm negotiating with an insurance and decided to test it. Of course they don't want to contract with it in place. As usual it's not my patients who are reacting but their children or others who don't get their care from me. I suspect two have been convinced to call their insurance. So I'm trying to be proactive rather than defensive when insurance agents walk me around corners. I know I'm right but I'm not always a fast responder. I'm trying to get the insurance agent to find out from their lawyers what wording would be acceptable. We'll see if my handing it back to them works successfully. To: Sent: Wednesday, February 29, 2012 6:01 PM Subject: Re: NCBF

I have never sent any letters to insurance companies. Twice I have gotten calls and ended up just leaving voicemail saying my noncovered benefits fee was not for administrative services and was specifically for services that insurance did not cover and I have never heard back.

Yes, fingers do remain crossed.

Does anyone have a non-covered benefit letter that the insurances accepted as not being in conflict with their contract?

[Guest guest]

Wishing you smooth sailing on this. Deborah Ginsburg, MDHealing Oceans Family Wellness Center Helping Families Thrivewww.healing-oceans.com Sent from my iPad

I'm negotiating with an insurance and decided to test it. Of course they don't want to contract with it in place. As usual it's not my patients who are reacting but their children or others who don't get their care from me. I suspect two have been convinced to call their insurance. So I'm trying to be proactive rather than defensive when insurance agents walk me around corners. I know I'm right but I'm not always a fast responder. I'm trying to get the insurance agent to find out from their lawyers what wording would be acceptable. We'll see if my handing it back to them works successfully. To: Sent: Wednesday, February 29, 2012 6:01 PM Subject: Re: NCBF

I have never sent any letters to insurance companies. Twice I have gotten calls and ended up just leaving voicemail saying my noncovered benefits fee was not for administrative services and was specifically for services that insurance did not cover and I have never heard back.

Yes, fingers do remain crossed.

Does anyone have a non-covered benefit letter that the insurances accepted as not being in conflict with their contract?

[Guest guest]

My last contract with Blue Cross actually proactively  says something in it like if you are going to charge a fee make sure you advise people and that i  tis for things we do not cover... or something.I would share it but

A I am sure  it would be illegal and B I bury those scary contracts in obscure closets.Jean

 

Wishing you smooth sailing on this. Deborah Ginsburg, MDHealing Oceans Family Wellness Center         Helping Families Thrivewww.healing-oceans.com 

Sent from my iPad

 

I'm negotiating with an insurance and decided to test it. Of course they don't want to contract with it in place. As usual it's not my patients who are reacting but their children or others who don't get their care from me.  I suspect two have been convinced to call their insurance.  So I'm trying to be proactive rather than defensive when insurance agents walk me around corners.  I know I'm right but I'm not always a fast responder.  I'm trying to get the insurance agent to find out from their lawyers what wording would be acceptable.  We'll see if my handing it back to them works successfully.  

To:

Sent: Wednesday, February 29, 2012 6:01 PM Subject: Re: NCBF

 

I have never sent any letters to insurance companies.  Twice I have gotten calls and ended up just leaving voicemail saying my noncovered benefits fee was not for administrative services and was specifically for services that insurance did not cover and I have never heard back.

Yes, fingers do remain crossed.

 

Does anyone have a non-covered benefit letter that the insurances accepted as not being in conflict with their contract?

--      MD          ph    fax

[Guest guest]

,I sent out letters 3 months in advance to all my patients announcing that I was going to institute my NCBF. This was at the end of 2007, with the fee taking effect in January 2008. I kept track of those who responded but I didn't keep statistics on what percentage responded. I estimated maybe 1/2 of my patient panel paid. If they didn't pay by January 1st, I would just wait until they made an appointment and remind them that I started charging this "extra fee". Almost all of them said, "Oh, I remember getting a letter from you…" and after I explained the fee, they said they would agree to pay it. A few times, patients would decline to pay it after my explanation, in which case I would not schedule an appointment for them and offer to give them names of other local doctors. I am not a lawyer but I think it is legal for you to decline to see a patient who does not agree to pay your fees. I have never had to formally discharge a patient because they refused to pay the NCBF. We just mutually agree to part ways. In my letter, I never explicitly say I won't take care of you if you don't pay the NCBF. But I do say if you want me to continue to be your doctor, I am going to charge you this NCBF, and are you OK with that? I also have a provision saying that if you have problems paying the fee due to financial reasons, please discuss it with the doctor. I have waived the fee, given discounts, bartered services with patients. I do not offer different levels of service, everyone gets treated the same, although they may not all pay the same amount, or at all. SetoSouth Pasadena, CA

I know this has been discussed alot, but don't recall the answer to this question, if so, sorry I missed it. For those of you that switched from straight insurance to NCBF plus insurance, how did you make the transition. What I mean is the logistics, sent a letter, and then gave patients how long to respond? Then kept track in computer? Is it legal to discharge people from the practice for not paying, I think not, it has to be voluntary. So then is is really legal or feasible to offer a dual level of service, some get the added benefits some don't. How do you word the I won't take care of you anymore if you don't, if you have done this? Cote' MD

[Guest guest]

,My initial situation of charging the fee was a little bit unique, because it was tied to me actually leaving my old office in setting up a brand-new practice.  There were a lot of other changes associated with this with the whole IMP model going into place.  I initially sent out a letter approximately 4 months before I was leaving stating that there was going to be a notable change, I was leaving the current practice (and the current practice was actually closing), and directed people to the website with frequently asked questions that included information about the fee.  I had a sign-up sheet on the website for patients that were interested in continuing and we called individually all the patients over the age of 70.  approximately one month before starting the new practice, I sent out formal registration materials including invoice for the fee to all the patients that had shown interest.  Again, the situation was a little unique because with my new practice I was having a limit on how many patients I would accept and thus there was a first come first serve mentality two things.when it was all said and done, I probably had about 12 to 1500 active patients originally and about 2000 total patients in the system that received letters.I set my limit at 500 patients that I would accept in the new practice and probably would've gotten about seven or 800 total if I allowed anybody who wanted to come and pay the fee.

Probably a more applicable situation in my case is when I raised my fee from $100-$300 after the first year.  In that situation, I sent out a letter in October with my reasons for raising the fee and the invoice for the $300.  It was due as of December 31 to continue being a patient. Some patients decided to move on to other practices and just let me know it was a mutual decision. Most patients just simply pay the increase.  There were obviously several patients that just simply didn't respond.  We did send some reminders at different points after the first of the year saying we had not heard from you please let us know of your continuing or not.  There were a handful of folks that still never responded.  I did not formally send them discharge notices.  However when they contacted me about care I provide it whatever they needed at that time and then inform them to make a decision whether they are staying in paying the fee or leaving.  The ones who stayed decided to pay and the ones who decided to leave I was happy to provide care for one or two months or update refills until they made their decision with your new physician was going to be.  I did not run into any issues where there was animosity or actual problems, even for the folks that were leaving.  When I increased from $100-$300 I ended up losing approximately 100 patients which was actually about my goal.

This year I just sent invoices by e-mail one month before they were due and the majority of people just paid on time.  We had to do a little follow-up than some people didn't get the e-mails but for the most part two months into the year I have heard back from probably 95% of people.  Another 40 patients approximately have left.  I now continue to take people off my waiting list in small amounts with the goal of maintaining a population of about 350 to 400 patients.

I agree with that as long as you are providing emergency care and informing them what your policies are there are no restrictions on what you can or cannot do.  However, I only play lawyer on TV.

 

,I sent out letters 3 months in advance to all my patients announcing that I was going to institute my NCBF. This was at the end of 2007, with the fee taking effect in January 2008. I kept track of those who responded but I didn't keep statistics on what percentage responded. I estimated maybe 1/2 of my patient panel paid. If they didn't pay by January 1st, I would just wait until they made an appointment and remind them that I started charging this " extra fee " . Almost all of them said, " Oh, I remember getting a letter from you… " and after I explained the fee, they said they would agree to pay it. A few times, patients would decline to pay it after my explanation, in which case I would not schedule an appointment for them and offer to give them names of other local doctors. 

I am not a lawyer but I think it is legal for you to decline to see a patient who does not agree to pay your fees. I have never had to formally discharge a patient because they refused to pay the NCBF. We just mutually agree to part ways. In my letter, I never explicitly say I won't take care of you if you don't pay the NCBF. But I do say if you want me to continue to be your doctor, I am going to charge you this NCBF, and are you OK with that? I also have a provision saying that if you have problems paying the fee due to financial reasons, please discuss it with the doctor. I have waived the fee, given discounts, bartered services with patients. I do not offer different levels of service, everyone gets treated the same, although they may not all pay the same amount, or at all. 

SetoSouth Pasadena, CA

 

I know this has been discussed alot, but don't recall the answer to this question, if so, sorry I missed it. For those of you that switched from straight insurance to NCBF plus insurance, how did you make the transition. What I mean is the logistics, sent a letter, and then gave patients how long to respond? 

Then kept track in computer?  Is it legal to discharge people from the practice for not paying, I think not, it has to be voluntary. So then is is really legal or feasible to offer a dual level of service, some get the added benefits some don't.  How do you word the I won't take care of you anymore if you don't, if you have done this?

Cote' MD

[Guest guest]

Thanks .

About 1 month ago I decided since the patients I polled didn't want this, I would try to be less IMP and just see 20 people a day. The patients have been okay with it, but I can't live with it, keep up paperwork or feel like I am doing everything that needs to be done,. I think it was who said, no one wants to pay more, but if it's the only choice many will. That is what I'm going to go with now.

To: Sent: Friday, March 2, 2012 10:45:53 AMSubject: Re: NCBF

, I sent out letters 3 months in advance to all my patients announcing that I was going to institute my NCBF. This was at the end of 2007, with the fee taking effect in January 2008. I kept track of those who responded but I didn't keep statistics on what percentage responded. I estimated maybe 1/2 of my patient panel paid. If they didn't pay by January 1st, I would just wait until they made an appointment and remind them that I started charging this "extra fee". Almost all of them said, "Oh, I remember getting a letter from you…" and after I explained the fee, they said they would agree to pay it. A few times, patients would decline to pay it after my explanation, in which case I would not schedule an appointment for them and offer to give them names of other local doctors.

I am not a lawyer but I think it is legal for you to decline to see a patient who does not agree to pay your fees. I have never had to formally discharge a patient because they refused to pay the NCBF. We just mutually agree to part ways. In my letter, I never explicitly say I won't take care of you if you don't pay the NCBF. But I do say if you want me to continue to be your doctor, I am going to charge you this NCBF, and are you OK with that? I also have a provision saying that if you have problems paying the fee due to financial reasons, please discuss it with the doctor. I have waived the fee, given discounts, bartered services with patients. I do not offer different levels of service, everyone gets treated the same, although they may not all pay the same amount, or at all.

Seto

South Pasadena, CA

I know this has been discussed alot, but don't recall the answer to this question, if so, sorry I missed it.

For those of you that switched from straight insurance to NCBF plus insurance, how did you make the transition. What I mean is the logistics, sent a letter, and then gave patients how long to respond?

Then kept track in computer? Is it legal to discharge people from the practice for not paying, I think not, it has to be voluntary. So then is is really legal or feasible to offer a dual level of service, some get the added benefits some don't. How do you word the I won't take care of you anymore if you don't, if you have done this?

Cote' MD

[Guest guest]

IMP Call Topic:  Non-Covered Benefits Feefeaturing Seto, MD

Thursday, April 5(11 am PT, noon MT, 1 pm CT, 2pm ET and recorded)

Join or renew your IMP membership now so you don't miss this and other great calls.....

Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

 

Thanks .

About 1 month ago I decided since the patients I polled didn't want this, I would try to be less IMP and just see 20 people a day. The patients have been okay with it, but I can't live with it, keep up paperwork or feel like I am doing everything that needs to be done,.  I think it was who said, no one wants to pay more, but if it's the only choice many will.  That is what I'm going to go with now.

To:

Sent: Friday, March 2, 2012 10:45:53 AMSubject: Re: NCBF

 

, I sent out letters 3 months in advance to all my patients announcing that I was going to institute my NCBF. This was at the end of 2007, with the fee taking effect in January 2008. I kept track of those who responded but I didn't keep statistics on what percentage responded. I estimated maybe 1/2 of my patient panel paid. If they didn't pay by January 1st, I would just wait until they made an appointment and remind them that I started charging this " extra fee " . Almost all of them said, " Oh, I remember getting a letter from you… " and after I explained the fee, they said they would agree to pay it. A few times, patients would decline to pay it after my explanation, in which case I would not schedule an appointment for them and offer to give them names of other local doctors. 

I am not a lawyer but I think it is legal for you to decline to see a patient who does not agree to pay your fees. I have never had to formally discharge a patient because they refused to pay the NCBF. We just mutually agree to part ways. In my letter, I never explicitly say I won't take care of you if you don't pay the NCBF. But I do say if you want me to continue to be your doctor, I am going to charge you this NCBF, and are you OK with that? I also have a provision saying that if you have problems paying the fee due to financial reasons, please discuss it with the doctor. I have waived the fee, given discounts, bartered services with patients. I do not offer different levels of service, everyone gets treated the same, although they may not all pay the same amount, or at all. 

Seto

South Pasadena, CA

 

I know this has been discussed alot, but don't recall the answer to this question, if so, sorry I missed it.

For those of you that switched from straight insurance to NCBF plus insurance, how did you make the transition. What I mean is the logistics, sent a letter, and then gave patients how long to respond? 

Then kept track in computer?  Is it legal to discharge people from the practice for not paying, I think not, it has to be voluntary. So then is is really legal or feasible to offer a dual level of service, some get the added benefits some don't.  How do you word the I won't take care of you anymore if you don't, if you have done this?

Cote' MD

[Guest guest]

Hi Sharon,

I just posted about my version of my NCBF which I state is specifically for 24x7

phone call availability. I know others are more vague about what the NCBF is

for, but I had a tough time justifying the NCBF when i think oregon gets pretty

well compensated for office visits.

I had BCBS breathe down my neck over it prompted by a nonpatient complaint and I

had to create an " opt-out " option but then it was accepted. Most patients do

not opt-out If this seems applicable to you feel free to look at what's on my

website - that is what BCBS did to check up on how I represented it to patients.

Stew Mones

Stewmonesmd.com

>

> Does anyone have a non-covered benefit letter that the insurances accepted as

not being in conflict with their contract?

>

[Guest guest]

Myria,

> >

> > Does anyone have a non-covered benefit letter that the insurances accepted

as not being in conflict with their contract?

> >

>

[Guest guest]

Stew,You are a godsend. This is exactly what I needed for the fee I am implementing. Thanks!Carla Gibson To: Sent: Friday, March 9, 2012 8:15 PM Subject: Re: NCBF

Myria,

> >

> > Does anyone have a non-covered benefit letter that the insurances accepted as not being in conflict with their contract?

> >

>

[Guest guest]

I can't see to get to your website to find your posting. I did read about your pallitive/phone care here. I re-worded my letter to clarify this is for patient convience and am waiting to see if this is not in conflict with insurance conttracts. I find myself very irked over a patient whose wife works for the insurance company objecting when it's her husband who continuously runs out of his BP meds and he drops in and I give up lunch, etc. Never fails, the ones you give the most extra too are the first to complain! I haven't decided if I'm going to dismiss folks if they don't pay but I too don't want to get involved in two tiered medicine. One insurance compnay offered to increase all my office visits by 10% if I would excuse their patients from the NCBF. That

felt wrong to me. The phone availability was one of the things the insurance rep harped on since coverage is required and it was my choice to not hire an answering service.I'll keep changing my letter til the reps and lawyers stop harping that it is in violation of contract. I've simply heard way too many "you came on Thanksgiving, you called me back on vacation, you called me between visits, you were with me every step of the way and eventually found out my abdominal pain was due to Lyme disease, you listen...." as well as the "you make home visits, you give me the time I need" and "it's cheaper than paying for gas to go elsewhere and sit for an hour" which isn't as complimentary but still true. To: Sent: Friday, March 9, 2012 10:15 PM Subject: Re: NCBF

Myria,

> >

> > Does anyone have a non-covered benefit letter that the insurances accepted as not being in conflict with their contract?

> >

>

[Guest guest]

http://www.stewmonesmd.com/Home/Policies

Don't know why the link didn't work before, but it didn't for me either.

Thanks for sharing Stew.

Don't your insurance contracts require 24 hour access?  Or do we just put that burdon on ourselves?

Will you be able to make the April 5 IMP call, Stew?  It is on NCBF.

I'm trying to understand your palliative care/primary care difference. So, basically, you charge a higher fee for a non patient who joins your practice for the palliative care coverage?

Sharon 

 

I can't see to get to your website to find your posting. I did read about your pallitive/phone care here.  I re-worded my letter to clarify this is for patient convience and am waiting to see if this is not in conflict with insurance conttracts. 

I find myself very irked over a patient whose wife works for the insurance company objecting when it's her husband who continuously runs out of his BP meds and he drops in and I give up lunch, etc.  Never fails, the ones you give the most extra too are the first to complain!  I haven't decided if I'm going to dismiss folks if they don't pay but I too don't want to get involved in two tiered medicine.  One insurance compnay offered to increase all my office visits by 10% if I would excuse their patients from the NCBF.  That

felt wrong to me. The phone availability was one of the things the insurance rep harped on since coverage is required and it was my choice to not hire an answering service.I'll keep changing my letter til the reps and lawyers stop harping that it is in violation of contract.  I've simply heard way too many " you came on Thanksgiving, you called me back on vacation, you called me between visits, you were with me every step of the way and eventually found out my abdominal pain was due to Lyme disease, you listen.... " as well as the " you make home visits, you give me the time I need " and " it's cheaper than paying for gas to go elsewhere and sit for an hour "  which isn't as complimentary but still true.

 

To:

Sent: Friday, March 9, 2012 10:15 PM Subject: Re: NCBF

 

Myria,

> >

> > Does anyone have a non-covered benefit letter that the insurances accepted as not being in conflict with their contract?

> >

>

[Guest guest]

Myria,That irks me that he said "it was your choice to not have an answering system" as if your "choice" has nothing to do with better care. You are extending yourself to you patients rather than dishing them off to a doctor who doesn't know them - just because most doctors sign off at 5pm doesn't mean that is the best medicine.It seems it doesn't matter if we offer exceptional care if we can't sell it and represent it well (shrewdly)My thought is that we offer LOTS of perks but the key to being able to charge extra is to either keep it simple and vague or simple and extremely specific. Either NCBF is for everything that I provide that is "not billable" and "not covered" has no cpt code attached to - and there is a lot of crap like that. Supposedly if it's related to a recent office visit it is sort of under the global for that e/m - but there are oodles of faxes and forms and referrals and all sorts of stuff that the PCP is sort of suckered into handling. A good argument is to just say " it's for the stuff that is not covered by your insurance and not related directly to a billable e/m visit. Period." OR one can state what specifically it is for and this may be more treacherous because - it gives the insurance more to sink their teeth into - so one must be careful and read your contract well, be specific and be prepared to defend it. I could see them knocking down most arguments. Because each service we offer could be spun and reduced to either "basic requirement/obligation of every doctor/clinic", or "over and above what is necessary and therefore must be optional". But then if you make it optional, then you have no leverage and your patient gets the service for free or you find yourself making every cold come in and becoming high volume again.I keep thinking of Warren Buffett - he is certainly willing to pay more in taxes, but the IRS is going to have to ask him - and have the right to ask him to pay more. But even though he agrees that he should pay more, until someone makes him, he is not going to.My argument about paying for 24x7 access is that although we are required to provide coverage and access to A physician, no where does it ever say that we must give our patients 24x7 access to us specifically. I used to be in a 12 physician call panel and I know there are 20 and 30 physician call panels. The on call doctor says "go to the Ed" and certainly doesn't know the patient unless they the patient has a stroke of luck - so to speak. Nowhere do I sign in a contract to say I will be available to all my patients 24x7. When I have spoken to my insurance reps, I get personal. I have said "do you have your doctor's cell phone Number and permission to call him/her whenever you have a urgent need? Imagine what that would be like to know that a doctor who knows you and your family and cares about you is available to you 99% of the time (as I write this I'm on a 2 hour flight without VoIP - first time in about 4 months). I usually convince the rep that this is extraordinary care that 1) I am not obligated to provide and 2) is a good service that improves quality of care but unfortunately, because I provide more than is required, I have to let patients opt out. Those patients who "opt-out" can still reach me at 2 am but they either have to pay for the phone call, or be seen for a face to face. I cannot NOT be available to them, but I can charge for a non covered service. In essence the "opt-out" is a type of non binding ABN. I don't bill for true emergencies when i truely need to get them admitted or seen in ED but when it is a non urgent situation I can say "remember when you signed the opt out, you agreed that you would pay for phone call medicine that took the place of a visit - do you want me to address this problem over the phone now or do you want me to See you at 8:30 tomorrow. (so far no insurance company has challenged me that there is a covered CPT for phone calls but most patients pay or choose to come in so it hasn't ever come up. My approach has holes in it - it certainly not perfect but I'm relatively happy with it and ao are my patients. And as gordon has said in the past, NCBF has risks and is uncharted territory.AND I will be on the NCBF phone call too!Thanks for making it through this long one. This listserv rocks.StewStew

I can't see to get to your website to find your posting. I did read about your pallitive/phone care here. I re-worded my letter to clarify this is for patient convience and am waiting to see if this is not in conflict with insurance conttracts. I find myself very irked over a patient whose wife works for the insurance company objecting when it's her husband who continuously runs out of his BP meds and he drops in and I give up lunch, etc. Never fails, the ones you give the most extra too are the first to complain! I haven't decided if I'm going to dismiss folks if they don't pay but I too don't want to get involved in two tiered medicine. One insurance compnay offered to increase all my office visits by 10% if I would excuse their patients from the NCBF. That

felt wrong to me. The phone availability was one of the things the insurance rep harped on since coverage is required and it was my choice to not hire an answering service.I'll keep changing my letter til the reps and lawyers stop harping that it is in violation of contract. I've simply heard way too many "you came on Thanksgiving, you called me back on vacation, you called me between visits, you were with me every step of the way and eventually found out my abdominal pain was due to Lyme disease, you listen...." as well as the "you make home visits, you give me the time I need" and "it's cheaper than paying for gas to go elsewhere and sit for an hour" which isn't as complimentary but still true. To: Sent: Friday, March 9, 2012 10:15 PM Subject: Re: NCBF

Myria,

> >

> > Does anyone have a non-covered benefit letter that the insurances accepted as not being in conflict with their contract?

> >

>

[Guest guest]

Thanks Stew,I'll learn to be a better arguer yet. I'll borrow some of your lines.Will keep you posted.And will also be on the phone call.Myria To:

" " < > Sent: Saturday, March 10, 2012 11:29 PM Subject: Re: Re: NCBF

Myria,That irks me that he said "it was your choice to not have an answering system" as if your "choice" has nothing to do with better care. You are extending yourself to you patients rather than dishing them off to a doctor who doesn't know them - just because most doctors sign off at 5pm doesn't mean that is the best medicine.It seems it doesn't matter if we offer exceptional care if we can't sell it and represent it well (shrewdly)My thought is that we offer LOTS of perks but the key to being able to charge extra is to either keep it simple and vague or simple and extremely specific. Either NCBF is for everything that I provide that is "not billable" and "not covered" has no cpt code attached to - and there is a lot of crap like that. Supposedly if it's related to a recent office visit it is sort of under the global for that e/m - but there are oodles of faxes and forms and referrals and

all sorts of stuff that the PCP is sort of suckered into handling. A good argument is to just say " it's for the stuff that is not covered by your insurance and not related directly to a billable e/m visit. Period." OR one can state what specifically it is for and this may be more treacherous because - it gives the insurance more to sink their teeth into - so one must be careful and read your contract well, be specific and be prepared to defend it. I could see them knocking down most arguments. Because each service we offer could be spun and reduced to either "basic requirement/obligation of every doctor/clinic", or "over and above what is necessary and therefore must be optional". But then if you make it optional, then you have no leverage and your patient gets the service for free or you find yourself making every cold come in and becoming high volume again.I keep thinking of Warren Buffett - he is

certainly willing to pay more in taxes, but the IRS is going to have to ask him - and have the right to ask him to pay more. But even though he agrees that he should pay more, until someone makes him, he is not going to.My argument about paying for 24x7 access is that although we are required to provide coverage and access to A physician, no where does it ever say that we must give our patients 24x7 access to us specifically. I used to be in a 12 physician call panel and I know there are 20 and 30 physician call panels. The on call doctor says "go to the Ed" and certainly doesn't know the patient unless they the patient has a stroke of luck - so to speak. Nowhere do I sign in a contract to say I will be available to all my patients 24x7. When I have spoken to my insurance reps, I get personal. I have said "do you have your doctor's cell phone Number and

permission to call him/her whenever you have a urgent need? Imagine what that would be like to know that a doctor who knows you and your family and cares about you is available to you 99% of the time (as I write this I'm on a 2 hour flight without VoIP - first time in about 4 months). I usually convince the rep that this is extraordinary care that 1) I am not obligated to provide and 2) is a good service that improves quality of care but unfortunately, because I provide more than is required, I have to let patients opt out. Those patients who "opt-out" can still reach me at 2 am but they either have to pay for the phone call, or be seen for a face to face. I cannot NOT be available to them, but I can charge for a non covered service. In essence the "opt-out" is a type of non binding ABN. I don't bill for true emergencies when i truely need to get them admitted or seen in ED but when it is a non urgent situation I can say

"remember when you signed the opt out, you agreed that you would pay for phone call medicine that took the place of a visit - do you want me to address this problem over the phone now or do you want me to See you at 8:30 tomorrow. (so far no insurance company has challenged me that there is a covered CPT for phone calls but most patients pay or choose to come in so it hasn't ever come up. My approach has holes in it - it certainly not perfect but I'm relatively happy with it and ao are my patients. And as gordon has said in the past, NCBF has risks and is uncharted territory.AND I will be on the NCBF phone call too!Thanks for making it through this long one. This listserv rocks.StewStew

I can't see to get to your website to find your posting. I did read about your pallitive/phone care here. I re-worded my letter to clarify this is for patient convience and am waiting to see if this is not in conflict with insurance conttracts. I find myself very irked over a patient whose wife works for the insurance company objecting when it's her husband who continuously runs out of his BP meds and he drops in and I give up lunch, etc. Never fails, the ones you give the most extra too are the first to complain! I haven't decided if I'm going to dismiss folks if they don't pay but I too don't want to get involved in two tiered medicine. One insurance compnay offered to increase all my office visits by 10% if I would excuse their patients from

the NCBF. That

felt wrong to me. The phone availability was one of the things the insurance rep harped on since coverage is required and it was my choice to not hire an answering service.I'll keep changing my letter til the reps and lawyers stop harping that it is in violation of contract. I've simply heard way too many "you came on Thanksgiving, you called me back on vacation, you called me between visits, you were with me every step of the way and eventually found out my abdominal pain was due to Lyme disease, you listen...." as well as the "you make home visits, you give me the time I need" and "it's cheaper than paying for gas to go elsewhere and sit for an hour" which isn't as complimentary but still true. To: Sent: Friday, March 9, 2012 10:15 PM Subject: Re: NCBF

Myria,

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> > Does anyone have a non-covered benefit letter that the insurances accepted as not being in conflict with their contract?

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