Guest guest Posted May 8, 2012 Report Share Posted May 8, 2012 I actually got one , with a check attached telling me, depositing that check meant I agreed to ALL future rates as determined by them. The amount was actually decent ( I forget) , but ALL future ? Sangeetha I'm not following totally here ... MultiPlan is offering $210 but Aetna already sent a check? I won't contract with MultiPlan as their rates are low. When they send me these faxes, I send them back telling them what the " regional allowable " (my major payors are all the same) is for that service and suggesting they refax with that amount. They usually fax back something in the middle. If I'm not too irritated, I fax again and tell them the same thing I told them the first time. Then they fax back what I asked for, I sign and they pay. To: Sent: Monday, May 7, 2012 11:35 AM Subject: Multiplan I'm a new practice, am contracted with Aetna, and saw my first Aetna patient, the same guy now 3 times. I have since received faxes, for the first 2 visits, from a place called Multiplan, stating " Expedited Agreement " , with then offering to pay me some percent (like 70%) of what I billed. It says that I would be considered out of network. I called Aetna to ask them what this is and they said I can take the option, but the patient might get stuck with out-of-network costs...except no, wait, this patient has a 100% out of network benefit, so they pay nothing either way. The amount I billed Aetna was about $300. The amount I was offered from Multiplan was like $210. The amount I should get from Aetna, based on contract, is like $180. Someone please explain to me: why don't I just take the Multiplan option in this case? Some googling finds me discussions on Multiplan, where providers return their fax stating " no thanks, " and then multiplan ends up paying close to the full billed amount. Why don't I try that? And in the meantime, Aetna has told me that they have cut me a check for the $180..... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2012 Report Share Posted May 8, 2012 Yes Aetna is sending me a $180 check (I havent received it yet), and at the same time, Multiplan is offering me $210, for the same visit. Sangeetha did you deposit the check? Anyone else have experience with this Multiplan silliness? P.J. > > > ** > > > > > > I'm not following totally here ... MultiPlan is offering $210 but Aetna > > already sent a check? > > > > I won't contract with MultiPlan as their rates are low. When they send me > > these faxes, I send them back telling them what the " regional allowable " > > (my major payors are all the same) is for that service and suggesting they > > refax with that amount. They usually fax back something in the middle. If > > I'm not too irritated, I fax again and tell them the same thing I told them > > the first time. Then they fax back what I asked for, I sign and they pay. > > > > ------------------------------ > > *From:* practiceimprovementalias > > *To:* > > *Sent:* Monday, May 7, 2012 11:35 AM > > *Subject:* Multiplan > > > > > > I'm a new practice, am contracted with Aetna, and saw my first Aetna > > patient, the same guy now 3 times. I have since received faxes, for the > > first 2 visits, from a place called Multiplan, stating " Expedited > > Agreement " , with then offering to pay me some percent (like 70%) of what I > > billed. It says that I would be considered out of network. I called Aetna > > to ask them what this is and they said I can take the option, but the > > patient might get stuck with out-of-network costs...except no, wait, this > > patient has a 100% out of network benefit, so they pay nothing either way. > > The amount I billed Aetna was about $300. The amount I was offered from > > Multiplan was like $210. The amount I should get from Aetna, based on > > contract, is like $180. > > > > Someone please explain to me: why don't I just take the Multiplan option > > in this case? > > > > Some googling finds me discussions on Multiplan, where providers return > > their fax stating " no thanks, " and then multiplan ends up paying close to > > the full billed amount. Why don't I try that? > > > > And in the meantime, Aetna has told me that they have cut me a check for > > the $180..... > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2012 Report Share Posted May 8, 2012 I didnt, not when it is soooo underhandSangeetha Yes Aetna is sending me a $180 check (I havent received it yet), and at the same time, Multiplan is offering me $210, for the same visit. Sangeetha did you deposit the check? Anyone else have experience with this Multiplan silliness? P.J. > > > ** > > > > > > I'm not following totally here ... MultiPlan is offering $210 but Aetna > > already sent a check? > > > > I won't contract with MultiPlan as their rates are low. When they send me > > these faxes, I send them back telling them what the " regional allowable " > > (my major payors are all the same) is for that service and suggesting they > > refax with that amount. They usually fax back something in the middle. If > > I'm not too irritated, I fax again and tell them the same thing I told them > > the first time. Then they fax back what I asked for, I sign and they pay. > > > > ------------------------------ > > *From:* practiceimprovementalias > > *To:* > > *Sent:* Monday, May 7, 2012 11:35 AM > > *Subject:* Multiplan > > > > > > I'm a new practice, am contracted with Aetna, and saw my first Aetna > > patient, the same guy now 3 times. I have since received faxes, for the > > first 2 visits, from a place called Multiplan, stating " Expedited > > Agreement " , with then offering to pay me some percent (like 70%) of what I > > billed. It says that I would be considered out of network. I called Aetna > > to ask them what this is and they said I can take the option, but the > > patient might get stuck with out-of-network costs...except no, wait, this > > patient has a 100% out of network benefit, so they pay nothing either way. > > The amount I billed Aetna was about $300. The amount I was offered from > > Multiplan was like $210. The amount I should get from Aetna, based on > > contract, is like $180. > > > > Someone please explain to me: why don't I just take the Multiplan option > > in this case? > > > > Some googling finds me discussions on Multiplan, where providers return > > their fax stating " no thanks, " and then multiplan ends up paying close to > > the full billed amount. Why don't I try that? > > > > And in the meantime, Aetna has told me that they have cut me a check for > > the $180..... > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 8, 2012 Report Share Posted May 8, 2012 P.J., If you are contracted with Aetna, I think you have to accept their allowable as payment in full. That is what your contract says. I guarantee that someone else isn't going to come in and offer you more, without some ulterior motive. Sangeetha's experience doesn't surprise me a bit. The other thing I have always worried about with Multiplan is that they might sell my participating provider status to other insurers. I have heard of that being done, but I forget what it is called.---Sharlene > > > > > ** > > > > > > > > > I'm not following totally here ... MultiPlan is offering $210 but Aetna > > > already sent a check? > > > > > > I won't contract with MultiPlan as their rates are low. When they send me > > > these faxes, I send them back telling them what the " regional allowable " > > > (my major payors are all the same) is for that service and suggesting they > > > refax with that amount. They usually fax back something in the middle. If > > > I'm not too irritated, I fax again and tell them the same thing I told them > > > the first time. Then they fax back what I asked for, I sign and they pay. > > > > > > ------------------------------ > > > *From:* practiceimprovementalias <pjparmar1@> > > > *To:* > > > *Sent:* Monday, May 7, 2012 11:35 AM > > > *Subject:* Multiplan > > > > > > > > > I'm a new practice, am contracted with Aetna, and saw my first Aetna > > > patient, the same guy now 3 times. I have since received faxes, for the > > > first 2 visits, from a place called Multiplan, stating " Expedited > > > Agreement " , with then offering to pay me some percent (like 70%) of what I > > > billed. It says that I would be considered out of network. I called Aetna > > > to ask them what this is and they said I can take the option, but the > > > patient might get stuck with out-of-network costs...except no, wait, this > > > patient has a 100% out of network benefit, so they pay nothing either way. > > > The amount I billed Aetna was about $300. The amount I was offered from > > > Multiplan was like $210. The amount I should get from Aetna, based on > > > contract, is like $180. > > > > > > Someone please explain to me: why don't I just take the Multiplan option > > > in this case? > > > > > > Some googling finds me discussions on Multiplan, where providers return > > > their fax stating " no thanks, " and then multiplan ends up paying close to > > > the full billed amount. Why don't I try that? > > > > > > And in the meantime, Aetna has told me that they have cut me a check for > > > the $180..... > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2012 Report Share Posted May 9, 2012 It actually looked remarkably like a legit eob, with a check attached, and with this in small printSangeetha I actually got one , with a check attached telling me, depositing that check meant I agreed to ALL future rates as determined by them. The amount was actually decent ( I forget) , but ALL future ? Sangeetha I'm not following totally here ... MultiPlan is offering $210 but Aetna already sent a check? I won't contract with MultiPlan as their rates are low. When they send me these faxes, I send them back telling them what the " regional allowable " (my major payors are all the same) is for that service and suggesting they refax with that amount. They usually fax back something in the middle. If I'm not too irritated, I fax again and tell them the same thing I told them the first time. Then they fax back what I asked for, I sign and they pay. To: Sent: Monday, May 7, 2012 11:35 AM Subject: Multiplan I'm a new practice, am contracted with Aetna, and saw my first Aetna patient, the same guy now 3 times. I have since received faxes, for the first 2 visits, from a place called Multiplan, stating " Expedited Agreement " , with then offering to pay me some percent (like 70%) of what I billed. It says that I would be considered out of network. I called Aetna to ask them what this is and they said I can take the option, but the patient might get stuck with out-of-network costs...except no, wait, this patient has a 100% out of network benefit, so they pay nothing either way. The amount I billed Aetna was about $300. The amount I was offered from Multiplan was like $210. The amount I should get from Aetna, based on contract, is like $180. Someone please explain to me: why don't I just take the Multiplan option in this case? Some googling finds me discussions on Multiplan, where providers return their fax stating " no thanks, " and then multiplan ends up paying close to the full billed amount. Why don't I try that? And in the meantime, Aetna has told me that they have cut me a check for the $180..... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2012 Report Share Posted May 9, 2012 I did many years ago, and would send it back to them with something like ‘only full contracted payment will be accepted’ as they were trying to pay ~50-75% of what was due. Then they usually paid the full amount. The way they had it worded, they were contracted by the insurance co to reimburse me. I suspect they were getting the full amount from the insurance co, and hoping to pocket the difference between that and what I got paid. Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of practiceimprovementalias Sent: Tuesday, May 08, 2012 2:26 PM To: Subject: Re: Multiplan Yes Aetna is sending me a $180 check (I havent received it yet), and at the same time, Multiplan is offering me $210, for the same visit. Sangeetha did you deposit the check? Anyone else have experience with this Multiplan silliness? P.J. > > > ** > > > > > > I'm not following totally here ... MultiPlan is offering $210 but Aetna > > already sent a check? > > > > I won't contract with MultiPlan as their rates are low. When they send me > > these faxes, I send them back telling them what the " regional allowable " > > (my major payors are all the same) is for that service and suggesting they > > refax with that amount. They usually fax back something in the middle. If > > I'm not too irritated, I fax again and tell them the same thing I told them > > the first time. Then they fax back what I asked for, I sign and they pay. > > > > ------------------------------ > > *From:* practiceimprovementalias > > *To:* > > *Sent:* Monday, May 7, 2012 11:35 AM > > *Subject:* Multiplan > > > > > > I'm a new practice, am contracted with Aetna, and saw my first Aetna > > patient, the same guy now 3 times. I have since received faxes, for the > > first 2 visits, from a place called Multiplan, stating " Expedited > > Agreement " , with then offering to pay me some percent (like 70%) of what I > > billed. It says that I would be considered out of network. I called Aetna > > to ask them what this is and they said I can take the option, but the > > patient might get stuck with out-of-network costs...except no, wait, this > > patient has a 100% out of network benefit, so they pay nothing either way. > > The amount I billed Aetna was about $300. The amount I was offered from > > Multiplan was like $210. The amount I should get from Aetna, based on > > contract, is like $180. > > > > Someone please explain to me: why don't I just take the Multiplan option > > in this case? > > > > Some googling finds me discussions on Multiplan, where providers return > > their fax stating " no thanks, " and then multiplan ends up paying close to > > the full billed amount. Why don't I try that? > > > > And in the meantime, Aetna has told me that they have cut me a check for > > the $180..... > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2012 Report Share Posted May 9, 2012 Yes, used to get this stuff all the time. I usually got them when Multiplan had gotten a major carrier backed self-funded plan for a local employer to sign up with them for claims administration. They are generally trying to generate a list of providers to show to a potential employer they are trying o con into letting them manage their plan. They have to show a certain percentage of coverage for the plan by local physicians for the state insurance commissioners to approve the managed self-funded plans that employers are rolling out to their employees these days. Real good read on Beech street & Multiplan on CNN website. Beech street is the other big player in this market. Another way of handling getting participating providers is done by PHCS – Which markets themselves to employers as an insurance plan when in actuality they are nothing more than a different way of providing the same end result. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of practiceimprovementaliasSent: Tuesday, May 08, 2012 4:26 PMTo: Subject: Re: Multiplan Yes Aetna is sending me a $180 check (I havent received it yet), and at the same time, Multiplan is offering me $210, for the same visit. Sangeetha did you deposit the check?Anyone else have experience with this Multiplan silliness?P.J.> > > **> >> >> > I'm not following totally here ... MultiPlan is offering $210 but Aetna> > already sent a check?> >> > I won't contract with MultiPlan as their rates are low. When they send me> > these faxes, I send them back telling them what the " regional allowable " > > (my major payors are all the same) is for that service and suggesting they> > refax with that amount. They usually fax back something in the middle. If> > I'm not too irritated, I fax again and tell them the same thing I told them> > the first time. Then they fax back what I asked for, I sign and they pay.> >> > ------------------------------> > *From:* practiceimprovementalias > > *To:* > > *Sent:* Monday, May 7, 2012 11:35 AM> > *Subject:* Multiplan> >> >> > I'm a new practice, am contracted with Aetna, and saw my first Aetna> > patient, the same guy now 3 times. I have since received faxes, for the> > first 2 visits, from a place called Multiplan, stating " Expedited> > Agreement " , with then offering to pay me some percent (like 70%) of what I> > billed. It says that I would be considered out of network. I called Aetna> > to ask them what this is and they said I can take the option, but the> > patient might get stuck with out-of-network costs...except no, wait, this> > patient has a 100% out of network benefit, so they pay nothing either way.> > The amount I billed Aetna was about $300. The amount I was offered from> > Multiplan was like $210. The amount I should get from Aetna, based on> > contract, is like $180.> >> > Someone please explain to me: why don't I just take the Multiplan option> > in this case?> >> > Some googling finds me discussions on Multiplan, where providers return> > their fax stating " no thanks, " and then multiplan ends up paying close to> > the full billed amount. Why don't I try that?> >> > And in the meantime, Aetna has told me that they have cut me a check for> > the $180.....> >> >> >> > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2012 Report Share Posted May 9, 2012 If I am not mistaken, Beech street was acquired by Multiplan. Multiplan and PHCS are notorious for high deductible PPO plans in CO and they take their full state required maximum of 6 weeks to process any claim ( if I even get an EOB back without complaint). Pain in my a-- to get paid. g To: Sent: Wednesday, May 9, 2012 12:21 PMSubject: RE: Re: Multiplan Yes, used to get this stuff all the time. I usually got them when Multiplan had gotten a major carrier backed self-funded plan for a local employer to sign up with them for claims administration. They are generally trying to generate a list of providers to show to a potential employer they are trying o con into letting them manage their plan. They have to show a certain percentage of coverage for the plan by local physicians for the state insurance commissioners to approve the managed self-funded plans that employers are rolling out to their employees these days. Real good read on Beech street & Multiplan on CNN website. Beech street is the other big player in this market. Another way of handling getting participating providers is done by PHCS – Which markets themselves to employers as an insurance plan when in actuality they are nothing more than a different way of providing the same end result. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of practiceimprovementaliasSent: Tuesday, May 08, 2012 4:26 PMTo: Subject: Re: Multiplan Yes Aetna is sending me a $180 check (I havent received it yet), and at the same time, Multiplan is offering me $210, for the same visit. Sangeetha did you deposit the check?Anyone else have experience with this Multiplan silliness?P.J.> > > **> >> >> > I'm not following totally here ... MultiPlan is offering $210 but Aetna> > already sent a check?> >> > I won't contract with MultiPlan as their rates are low. When they send me> > these faxes, I send them back telling them what the "regional allowable"> > (my major payors are all the same) is for that service and suggesting they> > refax with that amount. They usually fax back something in the middle. If> > I'm not too irritated, I fax again and tell them the same thing I told them> > the first time. Then they fax back what I asked for, I sign and they pay.> >> > ------------------------------> > *From:* practiceimprovementalias > > *To:* > > *Sent:* Monday, May 7, 2012 11:35 AM> > *Subject:* Multiplan> >> >> > I'm a new practice, am contracted with Aetna, and saw my first Aetna> > patient, the same guy now 3 times. I have since received faxes, for the> > first 2 visits, from a place called Multiplan, stating "Expedited> > Agreement", with then offering to pay me some percent (like 70%) of what I> > billed. It says that I would be considered out of network. I called Aetna> > to ask them what this is and they said I can take the option, but the> > patient might get stuck with out-of-network costs...except no, wait, this> > patient has a 100% out of network benefit, so they pay nothing either way.> > The amount I billed Aetna was about $300. The amount I was offered from> > Multiplan was like $210. The amount I should get from Aetna, based on> > contract, is like $180.> >> > Someone please explain to me: why don't I just take the Multiplan option> > in this case?> >> > Some googling finds me discussions on Multiplan, where providers return> > their fax stating "no thanks," and then multiplan ends up paying close to> > the full billed amount. Why don't I try that?> >> > And in the meantime, Aetna has told me that they have cut me a check for> > the $180.....> >> >> >> > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 9, 2012 Report Share Posted May 9, 2012 While I have seen the Multiplan offers, seeing it as masquerading as a legitimate eob was new to me. Is this how the main payers honor their contracts ?Because surely they get their information from the patients' insurance companies. Sangeetha If I am not mistaken, Beech street was acquired by Multiplan. Multiplan and PHCS are notorious for high deductible PPO plans in CO and they take their full state required maximum of 6 weeks to process any claim ( if I even get an EOB back without complaint). Pain in my a-- to get paid. g To: Sent: Wednesday, May 9, 2012 12:21 PM Subject: RE: Re: Multiplan Yes, used to get this stuff all the time. I usually got them when Multiplan had gotten a major carrier backed self-funded plan for a local employer to sign up with them for claims administration. They are generally trying to generate a list of providers to show to a potential employer they are trying o con into letting them manage their plan. They have to show a certain percentage of coverage for the plan by local physicians for the state insurance commissioners to approve the managed self-funded plans that employers are rolling out to their employees these days. Real good read on Beech street & Multiplan on CNN website. Beech street is the other big player in this market. Another way of handling getting participating providers is done by PHCS – Which markets themselves to employers as an insurance plan when in actuality they are nothing more than a different way of providing the same end result. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of practiceimprovementalias Sent: Tuesday, May 08, 2012 4:26 PMTo: Subject: Re: Multiplan Yes Aetna is sending me a $180 check (I havent received it yet), and at the same time, Multiplan is offering me $210, for the same visit. Sangeetha did you deposit the check?Anyone else have experience with this Multiplan silliness? P.J.> > > **> >> >> > I'm not following totally here ... MultiPlan is offering $210 but Aetna > > already sent a check?> >> > I won't contract with MultiPlan as their rates are low. When they send me> > these faxes, I send them back telling them what the " regional allowable " > > (my major payors are all the same) is for that service and suggesting they> > refax with that amount. They usually fax back something in the middle. If> > I'm not too irritated, I fax again and tell them the same thing I told them > > the first time. Then they fax back what I asked for, I sign and they pay.> >> > ------------------------------> > *From:* practiceimprovementalias > > *To:* > > *Sent:* Monday, May 7, 2012 11:35 AM> > *Subject:* Multiplan > >> >> > I'm a new practice, am contracted with Aetna, and saw my first Aetna> > patient, the same guy now 3 times. I have since received faxes, for the> > first 2 visits, from a place called Multiplan, stating " Expedited > > Agreement " , with then offering to pay me some percent (like 70%) of what I> > billed. It says that I would be considered out of network. I called Aetna> > to ask them what this is and they said I can take the option, but the > > patient might get stuck with out-of-network costs...except no, wait, this> > patient has a 100% out of network benefit, so they pay nothing either way.> > The amount I billed Aetna was about $300. The amount I was offered from > > Multiplan was like $210. The amount I should get from Aetna, based on> > contract, is like $180.> >> > Someone please explain to me: why don't I just take the Multiplan option > > in this case?> >> > Some googling finds me discussions on Multiplan, where providers return> > their fax stating " no thanks, " and then multiplan ends up paying close to > > the full billed amount. Why don't I try that?> >> > And in the meantime, Aetna has told me that they have cut me a check for> > the $180.....> >> >> > > > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 10, 2012 Report Share Posted May 10, 2012 I'm out of network for all insurances. I used to try to fax back or call Multiplan and ask them to stop pestering me. Didn't work. Now I just delete, they try 2 or 3 more times for each bill (was mainly Cigna for me) and then Cigna would send a larger amount shortly after. My advice, don't give them your valuable energy or time; delete and smile. SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com While I have seen the Multiplan offers, seeing it as masquerading as a legitimate eob was new to me. Is this how the main payers honor their contracts ?Because surely they get their information from the patients' insurance companies. Sangeetha If I am not mistaken, Beech street was acquired by Multiplan. Multiplan and PHCS are notorious for high deductible PPO plans in CO and they take their full state required maximum of 6 weeks to process any claim ( if I even get an EOB back without complaint). Pain in my a-- to get paid. g To: Sent: Wednesday, May 9, 2012 12:21 PM Subject: RE: Re: Multiplan Yes, used to get this stuff all the time. I usually got them when Multiplan had gotten a major carrier backed self-funded plan for a local employer to sign up with them for claims administration. They are generally trying to generate a list of providers to show to a potential employer they are trying o con into letting them manage their plan. They have to show a certain percentage of coverage for the plan by local physicians for the state insurance commissioners to approve the managed self-funded plans that employers are rolling out to their employees these days. Real good read on Beech street & Multiplan on CNN website. Beech street is the other big player in this market. Another way of handling getting participating providers is done by PHCS – Which markets themselves to employers as an insurance plan when in actuality they are nothing more than a different way of providing the same end result. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of practiceimprovementalias Sent: Tuesday, May 08, 2012 4:26 PMTo: Subject: Re: Multiplan Yes Aetna is sending me a $180 check (I havent received it yet), and at the same time, Multiplan is offering me $210, for the same visit. Sangeetha did you deposit the check?Anyone else have experience with this Multiplan silliness? P.J.> > > **> >> >> > I'm not following totally here ... MultiPlan is offering $210 but Aetna > > already sent a check?> >> > I won't contract with MultiPlan as their rates are low. When they send me> > these faxes, I send them back telling them what the " regional allowable " > > (my major payors are all the same) is for that service and suggesting they> > refax with that amount. They usually fax back something in the middle. If> > I'm not too irritated, I fax again and tell them the same thing I told them > > the first time. Then they fax back what I asked for, I sign and they pay.> >> > ------------------------------> > *From:* practiceimprovementalias > > *To:* > > *Sent:* Monday, May 7, 2012 11:35 AM> > *Subject:* Multiplan > >> >> > I'm a new practice, am contracted with Aetna, and saw my first Aetna> > patient, the same guy now 3 times. I have since received faxes, for the> > first 2 visits, from a place called Multiplan, stating " Expedited > > Agreement " , with then offering to pay me some percent (like 70%) of what I> > billed. It says that I would be considered out of network. I called Aetna> > to ask them what this is and they said I can take the option, but the > > patient might get stuck with out-of-network costs...except no, wait, this> > patient has a 100% out of network benefit, so they pay nothing either way.> > The amount I billed Aetna was about $300. The amount I was offered from > > Multiplan was like $210. The amount I should get from Aetna, based on> > contract, is like $180.> >> > Someone please explain to me: why don't I just take the Multiplan option > > in this case?> >> > Some googling finds me discussions on Multiplan, where providers return> > their fax stating " no thanks, " and then multiplan ends up paying close to > > the full billed amount. Why don't I try that?> >> > And in the meantime, Aetna has told me that they have cut me a check for> > the $180.....> >> >> > > > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2012 Report Share Posted May 12, 2012 Called "silent" PPO, yes they are legit, stealing your money.Your name was "sold" to them by another company.The other company that does slimy things like this is "Devon" and those guys pay about 60%Good luck staying out of these plans, not always possible.M in Western PATo: Sent: Wednesday, May 9, 2012 11:56:36 PMSubject: Re: Re: Multiplan I'm out of network for all insurances. I used to try to fax back or call Multiplan and ask them to stop pestering me. Didn't work. Now I just delete, they try 2 or 3 more times for each bill (was mainly Cigna for me) and then Cigna would send a larger amount shortly after. My advice, don't give them your valuable energy or time; delete and smile. SharonSharon McCoy MDRenaissance Family Medicine 10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com While I have seen the Multiplan offers, seeing it as masquerading as a legitimate eob was new to me. Is this how the main payers honor their contracts ?Because surely they get their information from the patients' insurance companies. Sangeetha If I am not mistaken, Beech street was acquired by Multiplan. Multiplan and PHCS are notorious for high deductible PPO plans in CO and they take their full state required maximum of 6 weeks to process any claim ( if I even get an EOB back without complaint). Pain in my a-- to get paid. g To: Sent: Wednesday, May 9, 2012 12:21 PM Subject: RE: Re: Multiplan Yes, used to get this stuff all the time. I usually got them when Multiplan had gotten a major carrier backed self-funded plan for a local employer to sign up with them for claims administration. They are generally trying to generate a list of providers to show to a potential employer they are trying o con into letting them manage their plan. They have to show a certain percentage of coverage for the plan by local physicians for the state insurance commissioners to approve the managed self-funded plans that employers are rolling out to their employees these days. Real good read on Beech street & Multiplan on CNN website. Beech street is the other big player in this market. Another way of handling getting participating providers is done by PHCS – Which markets themselves to employers as an insurance plan when in actuality they are nothing more than a different way of providing the same end result. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of practiceimprovementalias Sent: Tuesday, May 08, 2012 4:26 PMTo: Subject: Re: Multiplan Yes Aetna is sending me a $180 check (I havent received it yet), and at the same time, Multiplan is offering me $210, for the same visit. Sangeetha did you deposit the check?Anyone else have experience with this Multiplan silliness? P.J.> > > **> >> >> > I'm not following totally here ... MultiPlan is offering $210 but Aetna > > already sent a check?> >> > I won't contract with MultiPlan as their rates are low. When they send me> > these faxes, I send them back telling them what the "regional allowable" > > (my major payors are all the same) is for that service and suggesting they> > refax with that amount. They usually fax back something in the middle. If> > I'm not too irritated, I fax again and tell them the same thing I told them > > the first time. Then they fax back what I asked for, I sign and they pay.> >> > ------------------------------> > *From:* practiceimprovementalias > > *To:* > > *Sent:* Monday, May 7, 2012 11:35 AM> > *Subject:* Multiplan > >> >> > I'm a new practice, am contracted with Aetna, and saw my first Aetna> > patient, the same guy now 3 times. I have since received faxes, for the> > first 2 visits, from a place called Multiplan, stating "Expedited > > Agreement", with then offering to pay me some percent (like 70%) of what I> > billed. It says that I would be considered out of network. I called Aetna> > to ask them what this is and they said I can take the option, but the > > patient might get stuck with out-of-network costs...except no, wait, this> > patient has a 100% out of network benefit, so they pay nothing either way.> > The amount I billed Aetna was about $300. The amount I was offered from > > Multiplan was like $210. The amount I should get from Aetna, based on> > contract, is like $180.> >> > Someone please explain to me: why don't I just take the Multiplan option > > in this case?> >> > Some googling finds me discussions on Multiplan, where providers return> > their fax stating "no thanks," and then multiplan ends up paying close to > > the full billed amount. Why don't I try that?> >> > And in the meantime, Aetna has told me that they have cut me a check for> > the $180.....> >> >> > > > > >> Quote Link to comment Share on other sites More sharing options...
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