RE: Insurance billing question

[Guest guest]

I am opted out of Medicare and not taking

any private insurance. Surprisingly, I do have quite a few Medicare pts who pay

me at time of service, knowing they won’t get any $ back. But if you

really like geriatrics, you’ll probably want to take Medicare. Nursing

homes are even tougher…really need Medicare. However, I actually have one

nursing home pt…her son is my pt and he got fed up with the nursing home

doc, so he pays me cash every month to go see his mom (pays my house call fee).

For private insurance, there are so many

different employers that all policies differ regarding out-of-network

reimbursement. We tell pts (as we give them the CMS 1500 to submit themselves)

that their fee will be either applied to their deductible or reimbursed to some

degree, but we’ve found plans vary widely. Much of the time they haven’t

met their deductible. When they have, many plans reimburse decently (avg

probably 80% of my fee).

If you do sign up w/ insurances, many

prohibit you from billing pt for anything they don’t cover…read

contracts carefully!

Gretchen Reis MD

Wellspring Family Medicine

Circleville,

OH

From: [mailto: ] On Behalf Of

Sent: Friday, January 18, 2008

10:43 AM

To:

Subject:

Insurance billing question

I will be starting my IMP in the Los

Angeles area this summer and have many questions about

insurance billing.

I am thinking about not taking medicare but I do enjoy geriatrics and

nursing home care (did 6 months training program in geriatrics in Canada). My

premise for not taking medicare is their Rules and Regulations sound

strangulating.

Question one- if I am non participating, do I have to follow the same

RR as a participating doc? If I am non participating, I will have to bill the

pt first and then they get reimbursed directly from medicare ( ? at a lower

rate, right). If I opt out then the pt gets no reimbursement, correct? Is

anyone out there doing nursing home care w/o medicare?

Question two- for private insurance, if I see a pt who has say Cigna

and I have not signed up for Cigna, can the pt be reimbursed directly from

Cigna? Or does it depend on their plan?

Question three - If I am taking Blue Shield, and for some reason , Blue

Shield does not pay me, can I charge the pt an " administration " fee

for my hassle with their insurance company? Do some insurance forbid billing pt

directly if doc does not get paid?

I am thinking of starting out w just 2 or 3 insurance companies and non

participating in Medicare

Thanx in advance for your responses

--

M.D.

www.elainemd.com

[Guest guest]

Elaine,

I'm in Irvine. Where are you?

Sharon

At 07:43 AM 1/18/2008, you wrote:

I will be starting my IMP in the

Los Angeles area this summer and have many questions about insurance

billing.

I am thinking about not taking medicare but I do enjoy geriatrics and

nursing home care (did 6 months training program in geriatrics in

Canada). My premise for not taking medicare is their Rules and

Regulations sound strangulating.

Question one- if I am non participating, do I have to follow the same RR

as a participating doc? If I am non participating, I will have to bill

the pt first and then they get reimbursed directly from medicare ( ? at a

lower rate, right). If I opt out then the pt gets no reimbursement,

correct? Is anyone out there doing nursing home care w/o medicare?

Question two- for private insurance, if I see a pt who has say Cigna and

I have not signed up for Cigna, can the pt be reimbursed directly from

Cigna? Or does it depend on their plan?

Question three - If I am taking Blue Shield, and for some reason , Blue

Shield does not pay me, can I charge the pt an " administration "

fee for my hassle with their insurance company? Do some insurance forbid

billing pt directly if doc does not get paid?

I am thinking of starting out w just 2 or 3 insurance companies and non

participating in Medicare

Thanx in advance for your responses

--

M.D.

www.elainemd.com

[Guest guest]

Hi Sharon- I met you are your house last year. Good to hear from you. My practice will be in Montrose/Glendale. Trying to make sense of this insurance jungle...

Elaine,I'm in Irvine. Where are you?Sharon At 07:43 AM 1/18/2008, you wrote:

I will be starting my IMP in the Los Angeles area this summer and have many questions about insurance billing.I am thinking about not taking medicare but I do enjoy geriatrics and nursing home care (did 6 months training program in geriatrics in Canada). My premise for not taking medicare is their Rules and Regulations sound strangulating. Question one- if I am non participating, do I have to follow the same RR as a participating doc? If I am non participating, I will have to bill the pt first and then they get reimbursed directly from medicare ( ? at a lower rate, right). If I opt out then the pt gets no reimbursement, correct? Is anyone out there doing nursing home care w/o medicare? Question two- for private insurance, if I see a pt who has say Cigna and I have not signed up for Cigna, can the pt be reimbursed directly from Cigna? Or does it depend on their plan? Question three - If I am taking Blue Shield, and for some reason , Blue Shield does not pay me, can I charge the pt an " administration " fee for my hassle with their insurance company? Do some insurance forbid billing pt directly if doc does not get paid? I am thinking of starting out w just 2 or 3 insurance companies and non participating in MedicareThanx in advance for your responses-- M.D.

www.elainemd.com

-- M.D.

www.elainemd.com

[Guest guest]

Are you saying that some insurance companies do not let me bill their pts for services that they don't cover? Wow! I am planning on doing some acupuncture so I might not get paid for it if I have such a contract? It precludes their pts from receiving certain services? Wonder if pts know what they are signing up for. Or pts don't have a choice. Are insurance contracts negotiable? Thank you for your helpful input

I am opted out of Medicare and not taking any private insurance. Surprisingly, I do have quite a few Medicare pts who pay me at time of service, knowing they won't get any $ back. But if you really like geriatrics, you'll probably want to take Medicare. Nursing homes are even tougher…really need Medicare. However, I actually have one nursing home pt…her son is my pt and he got fed up with the nursing home doc, so he pays me cash every month to go see his mom (pays my house call fee).

For private insurance, there are so many different employers that all policies differ regarding out-of-network reimbursement. We tell pts (as we give them the CMS 1500 to submit themselves) that their fee will be either applied to their deductible or reimbursed to some degree, but we've found plans vary widely. Much of the time they haven't met their deductible. When they have, many plans reimburse decently (avg probably 80% of my fee).

If you do sign up w/ insurances, many prohibit you from billing pt for anything they don't cover…read contracts carefully!

Gretchen Reis MD

Wellspring Family Medicine

Circleville, OH

From:

[mailto: ]

On Behalf Of Sent: Friday, January 18, 2008 10:43 AMTo:

Subject: Insurance billing question

I will be starting my IMP in the Los Angeles area this summer and have many questions about insurance billing.

I am thinking about not taking medicare but I do enjoy geriatrics and nursing home care (did 6 months training program in geriatrics in Canada). My premise for not taking medicare is their Rules and Regulations sound strangulating.

Question one- if I am non participating, do I have to follow the same RR as a participating doc? If I am non participating, I will have to bill the pt first and then they get reimbursed directly from medicare ( ? at a lower rate, right). If I opt out then the pt gets no reimbursement, correct? Is anyone out there doing nursing home care w/o medicare?

Question two- for private insurance, if I see a pt who has say Cigna and I have not signed up for Cigna, can the pt be reimbursed directly from Cigna? Or does it depend on their plan?

Question three - If I am taking Blue Shield, and for some reason , Blue Shield does not pay me, can I charge the pt an " administration " fee for my hassle with their insurance company? Do some insurance forbid billing pt directly if doc does not get paid?

I am thinking of starting out w just 2 or 3 insurance companies and non participating in Medicare

Thanx in advance for your responses-- M.D.

www.elainemd.com

-- M.D.

www.elainemd.com

[Guest guest]

I thought that was you, Elaine. Great, glad it is going to

happen.

I think most of the problems with insurance contracts prohibiting fees

might be for a separate practice fee for phone/email/tech services.

Just check about the acupuncture, but I don't think that will be a

problem.

My practice (for those who don't know; Elaine, I know you do) is a

membership fee based, so patients pay a monthly fee and that includes

everything from me. It is a great way to practice; you can really

do what makes sense for taking good care of people rather than what you

need to do to generate income. I had to opt out of Medicare and I

don't contract with any insurance because as far as I know, none would

allow this type of charge. It is great not to be working for

insurance companies!

Sharon

At 12:02 PM 1/18/2008, you wrote:

Are you saying that some

insurance companies do not let me bill their pts for services that they

don't cover? Wow! I am planning on doing some acupuncture so I might not

get paid for it if I have such a contract? It precludes their pts from

receiving certain services? Wonder if pts know what they are signing up

for. Or pts don't have a choice. Are insurance contracts negotiable?

Thank you for your helpful input

On 1/18/08, Gretchen Reis MD

<

greis@...> wrote:

I am opted out of Medicare and not

taking any private insurance. Surprisingly, I do have quite a few

Medicare pts who pay me at time of service, knowing they won't get any $

back. But if you really like geriatrics, you'll probably want to take

Medicare. Nursing homes are even tougher…really need Medicare. However, I

actually have one nursing home pt…her son is my pt and he got fed up with

the nursing home doc, so he pays me cash every month to go see his mom

(pays my house call fee).

For private insurance, there are so many

different employers that all policies differ regarding out-of-network

reimbursement. We tell pts (as we give them the CMS 1500 to submit

themselves) that their fee will be either applied to their deductible or

reimbursed to some degree, but we've found plans vary widely. Much of the

time they haven't met their deductible. When they have, many plans

reimburse decently (avg probably 80% of my fee).

If you do sign up w/ insurances, many

prohibit you from billing pt for anything they don't cover…read contracts

carefully!

Gretchen Reis MD

Wellspring Family Medicine

Circleville, OH

From:

[

mailto: ] On Behalf Of Elaine

Chu

Sent: Friday, January 18, 2008 10:43 AM

To:

Subject: Insurance billing question

I will be starting my IMP in the

Los Angeles area this summer and have many questions about insurance

billing.

I am thinking about not taking

medicare but I do enjoy geriatrics and nursing home care (did 6 months

training program in geriatrics in Canada). My premise for not taking

medicare is their Rules and Regulations sound strangulating.

Question one- if I am non

participating, do I have to follow the same RR as a participating doc? If

I am non participating, I will have to bill the pt first and then they

get reimbursed directly from medicare ( ? at a lower rate, right). If I

opt out then the pt gets no reimbursement, correct? Is anyone out there

doing nursing home care w/o medicare?

Question two- for private

insurance, if I see a pt who has say Cigna and I have not signed up for

Cigna, can the pt be reimbursed directly from Cigna? Or does it depend on

their plan?

Question three - If I am taking

Blue Shield, and for some reason , Blue Shield does not pay me, can I

charge the pt an " administration " fee for my hassle with their

insurance company? Do some insurance forbid billing pt directly if doc

does not get paid?

I am thinking of starting out w

just 2 or 3 insurance companies and non participating in Medicare

Thanx in advance for your

responses

--

M.D.

www.elainemd.com

--

M.D.

www.elainemd.com

[Guest guest]

Are you saying that some insurance companies do not let me bill their

pts for services that they don't cover?

YES

Wow!

EXACTLY

I am planning on doing someacupuncture so I might not get paid for it if I

have such a contract?

YEP

It

precludes their pts from receiving certain services?

NO -it precludes you from chargeing for them.Maybe . Now it can be that it

does not preclude in the contract ,that it is permissible that you charge

for NONCOVERED services .Depends.DEpends on what--

Depends on which plan of which insuracne , whether you can understand it

,and sometimes the phases of the moon.

Are you fed up and confused yet.?

Sorry am havingn a slow day should get off emial but Elaine if you are not

confused and dismayed you are not paying attention.

Wonder if pts know what they are signing up for.

NO they do not know If we can't understand ,you think they do?

Or pts don't have a choice.

RIGHT

Are insurance contracts negotiable?

WELL< HARD BUT you should try

JOhn HArsesch and a few others have gotten them to agree to pay higher

rate s by writng to them-- Lynn ho set up a standard letter to use-it may

be in the files of the list serv somewhere... but I am not sure anyone has

negotiated having them pay for services that are not covered.

That would be sorta over the rainbow.

Now don';t get discouraged. You will work your way through it and we will

help you

but the situations stinks

..Unless you own the insurance company .

[Guest guest]

Did you start off cash only? How long did it take you to build up your practice? Are you in a wealthy neighborhood? Cash only or how Sharon is doing it sure sounds attractive.

I am opted out of Medicare and not taking any private insurance. Surprisingly, I do have quite a few Medicare pts who pay me at time of service, knowing they won't get any $ back. But if you really like geriatrics, you'll probably want to take Medicare. Nursing homes are even tougher…really need Medicare. However, I actually have one nursing home pt…her son is my pt and he got fed up with the nursing home doc, so he pays me cash every month to go see his mom (pays my house call fee).

For private insurance, there are so many different employers that all policies differ regarding out-of-network reimbursement. We tell pts (as we give them the CMS 1500 to submit themselves) that their fee will be either applied to their deductible or reimbursed to some degree, but we've found plans vary widely. Much of the time they haven't met their deductible. When they have, many plans reimburse decently (avg probably 80% of my fee).

If you do sign up w/ insurances, many prohibit you from billing pt for anything they don't cover…read contracts carefully!

Gretchen Reis MD

Wellspring Family Medicine

Circleville, OH

From:

[mailto: ]

On Behalf Of Sent: Friday, January 18, 2008 10:43 AMTo:

Subject: Insurance billing question

I will be starting my IMP in the Los Angeles area this summer and have many questions about insurance billing.

I am thinking about not taking medicare but I do enjoy geriatrics and nursing home care (did 6 months training program in geriatrics in Canada). My premise for not taking medicare is their Rules and Regulations sound strangulating.

Question one- if I am non participating, do I have to follow the same RR as a participating doc? If I am non participating, I will have to bill the pt first and then they get reimbursed directly from medicare ( ? at a lower rate, right). If I opt out then the pt gets no reimbursement, correct? Is anyone out there doing nursing home care w/o medicare?

Question two- for private insurance, if I see a pt who has say Cigna and I have not signed up for Cigna, can the pt be reimbursed directly from Cigna? Or does it depend on their plan?

Question three - If I am taking Blue Shield, and for some reason , Blue Shield does not pay me, can I charge the pt an " administration " fee for my hassle with their insurance company? Do some insurance forbid billing pt directly if doc does not get paid?

I am thinking of starting out w just 2 or 3 insurance companies and non participating in Medicare

Thanx in advance for your responses-- M.D.

www.elainemd.com

-- M.D.

www.elainemd.com

[Guest guest]

I opened a year ago and have about 500 pts….

economically depressed rural area which is making growth slow. That’s why

I’m thinking about taking some insurance. If you’re in LA, a model

like Sharon’s

can definitely work. (Wouldn’t really sell here in farm country, Ohio. People always

grumble about paying to see the doc, but it’s amazing how they always find

money for cigarettes!)

Gretchen Reis MD

Wellspring Family Medicine

Circleville,

OH

From: [mailto: ] On Behalf Of

Sent: Friday, January 18, 2008

3:54 PM

To:

Subject: Re:

Insurance billing question

Did you start off cash only? How long did it take you

to build up your practice? Are you in a wealthy neighborhood? Cash only or how Sharon is doing it sure

sounds attractive.

On 1/18/08, Gretchen

Reis MD <greiswellspringfamilymed>

wrote:

I am opted out of

Medicare and not taking any private insurance. Surprisingly, I do have quite a

few Medicare pts who pay me at time of service, knowing they won't get any $

back. But if you really like geriatrics, you'll probably want to take Medicare.

Nursing homes are even tougher…really need Medicare. However, I actually

have one nursing home pt…her son is my pt and he got fed up with the

nursing home doc, so he pays me cash every month to go see his mom (pays my

house call fee).

For private insurance,

there are so many different employers that all policies differ regarding

out-of-network reimbursement. We tell pts (as we give them the CMS 1500 to

submit themselves) that their fee will be either applied to their deductible or

reimbursed to some degree, but we've found plans vary widely. Much of the time

they haven't met their deductible. When they have, many plans reimburse

decently (avg probably 80% of my fee).

If you do sign up w/

insurances, many prohibit you from billing pt for anything they don't

cover…read contracts carefully!

Gretchen Reis MD

Wellspring Family Medicine

Circleville,

OH

From:

[mailto: ]

On Behalf Of

Sent: Friday, January 18, 2008

10:43 AM

To:

Subject:

Insurance billing question

I will be starting my IMP in the Los Angeles area this summer and have many

questions about insurance billing.

I am thinking about not taking medicare but I do enjoy

geriatrics and nursing home care (did 6 months training program in geriatrics

in Canada).

My premise for not taking medicare is their Rules and Regulations sound

strangulating.

Question one- if I am non participating, do I have to

follow the same RR as a participating doc? If I am non participating, I will

have to bill the pt first and then they get reimbursed directly from medicare (

? at a lower rate, right). If I opt out then the pt gets no reimbursement,

correct? Is anyone out there doing nursing home care w/o medicare?

Question two- for private insurance, if I see a pt who

has say Cigna and I have not signed up for Cigna, can the pt be reimbursed

directly from Cigna? Or does it depend on their plan?

Question three - If I am taking Blue Shield, and for

some reason , Blue Shield does not pay me, can I charge the pt an

" administration " fee for my hassle with their insurance company? Do

some insurance forbid billing pt directly if doc does not get paid?

I am thinking of starting out w just 2 or 3 insurance

companies and non participating in Medicare

Thanx in advance for your responses

--

M.D.

www.elainemd.com

--

M.D.

www.elainemd.com

[Guest guest]

OK I am sorry I was so crabby

but I hate insurance companies terribly That they should put out products

for something as valuable as health care, in a manner that even a super

educated phsyican cannot understandn is reprehensible.

Elaine -if it says you can bill for noncovered servcies ,that, for you with

acupuncture, is the biggest thing probably to watch for

I am cheered up having just seen one of my favorite kids( when I met him he

asked me Doctor , will you check my toes? so i did)

and today he is thoughtfully sad .Oh he sighed. I wish I had super powers.

me too.

Happy friday

I will get off email and go to t he nH to see Charlie who calls me squirt.

Jean

Insurance billing question

I will be starting my IMP in the Los Angeles area this summer and have

many questions about insurance billing.

I am thinking about not taking medicare but I do enjoy geriatrics and

nursing home care (did 6 months training program in geriatrics in

Canada). My premise for not taking medicare is their Rules and

Regulations sound strangulating.

Question one- if I am non participating, do I have to follow the same RR

as a participating doc? If I am non participating, I will have to bill

the pt first and then they get reimbursed directly from medicare ( ? at

a lower rate, right). If I opt out then the pt gets no reimbursement,

correct? Is anyone out there doing nursing home care w/o medicare?

Question two- for private insurance, if I see a pt who has say Cigna and

I have not signed up for Cigna, can the pt be reimbursed directly from

Cigna? Or does it depend on their plan?

Question three - If I am taking Blue Shield, and for some reason , Blue

Shield does not pay me, can I charge the pt an " administration " fee for

my hassle with their insurance company? Do some insurance forbid billing

pt directly if doc does not get paid?

I am thinking of starting out w just 2 or 3 insurance companies and non

participating in Medicare

Thanx in advance for your responses

--

M.D.

www.elainemd. <http://www.elainemd.com/> com

--

M.D.

www.elainemd. <http://www.elainemd.com> com