Tom/Physicans that don't take your insurance

[Guest guest]

Tom, the interesting part of this scenario is that the pain

clinic is part of the hospital – it is physically located in the hospital, but

somehow it must be a separate entity as my insurance covers my treatment as

part of the hospital (let's say I was admitted there), but not for treatment from

my pain management doctor who works there. I don’t understand how this is

possible. Any ideas???

nne

From:

VulvarDisorders [mailto:VulvarDisorders ] On

Behalf Of K. Ockler

Sent: Thursday, April 10, 2008 12:18 PM

To: VulvarDisorders

Subject: Re: Physicans that don't take your insurance

nne,

YOu can call them and ask them to sign a contract but usually the reason they

are non participating is the insurance reimbursement rates ar so lousy, the

practitioner can't make a buck and actually loose money if they treat you.

There may also be some outrageous policies and paperwork regulations that are

just too much for the practitioner to bother with. All designed to steer

you to the practioners that do accept the insurance compnaies lousy rates and

policies.

Tom Ockler P.T.

www.tomocklerpt.com

winterberrypath wrote:

My pain management doctor is out of network

insurance for me. It wasn't

too bad last year, but this year the payment is only 30 percent. Again,

I can pay it for just a visit, but I have been getting trigger point

injections and I am considering Botox. The costs are too high for me to

pay for the injections. Someone mentioned to me once, that you can call

the physician's billing office and ask them to sign a contract with

your insurance company. Does anyone know if this is true, or has anyone

tried it?

nne

[Guest guest]

Dear nne,

I had a similar problem, actually. I got an MRI done at an approved facility that accepts my insurance. And they paid for the MRI test. However, the radiologist at the facility who read the films and wrote the report was not on my insurance, so they refused to pay her fee, even though she worked at a covered facility!

After speaking to the billing departments for the hospital the facility was connected with, the facility itself, and my insurance company several times, I finally was able to get them to cover it. However, I had to pay out of pocket and be reimbursed, because by then the bill was already in collections and my credit would've been shot by it.

The thing that was finally successful: call the insurance company and file an appeal, because the hospital is an approved hospital on my plan. I'm not sure if it'd work out exactly the same way in your case, but I do hope you are able to get them to cover it one way or another!

~~

Tom/Physicans that don't take your insurance

Tom, the interesting part of this scenario is that the pain clinic is part of the hospital – it is physically located in the hospital, but somehow it must be a separate entity as my insurance covers my treatment as part of the hospital (let's say I was admitted there), but not for treatment from my pain management doctor who works there. I don’t understand how this is possible. Any ideas???

nne

From: VulvarDisorders [mailto:VulvarDisorders ] On Behalf Of K. OcklerSent: Thursday, April 10, 2008 12:18 PMTo: VulvarDisorders Subject: Re: Physicans that don't take your insurance

nne,YOu can call them and ask them to sign a contract but usually the reason they are non participating is the insurance reimbursement rates ar so lousy, the practitioner can't make a buck and actually loose money if they treat you. There may also be some outrageous policies and paperwork regulations that are just too much for the practitioner to bother with. All designed to steer you to the practioners that do accept the insurance compnaies lousy rates and policies.Tom Ockler P.T.www.tomocklerpt.comwinterberrypath wrote:

My pain management doctor is out of network insurance for me. It wasn't too bad last year, but this year the payment is only 30 percent. Again, I can pay it for just a visit, but I have been getting trigger point injections and I am considering Botox. The costs are too high for me to pay for the injections. Someone mentioned to me once, that you can call the physician's billing office and ask them to sign a contract with your insurance company. Does anyone know if this is true, or has anyone tried it?nne

[Guest guest]

Whenever (in my area) you go to a medical facility or a doctor they will give

you a form to sign stating that if your insurance does not pay for their

services, that you will pay. I always read all the forms carefully that they

hand you to sign and I always find that statement somewhere and cross out and

initial the statement stating that I will pay if my insurance does not.

Sometimes it seems that they even try to hide it - I have even found it on the

form that you sign to indicate that you have been given a copy of the privacy

form.

Ora

>Dear nne,

>

>I had a similar problem, actually. I got an MRI done at an approved facility

that accepts my insurance. And they paid for the MRI test. However, the

radiologist at the facility who read the films and wrote the report was not on

my insurance, so they refused to pay her fee, even though she worked at a

covered facility!

>

>After speaking to the billing departments for the hospital the facility was

connected with, the facility itself, and my insurance company several times, I

finally was able to get them to cover it. However, I had to pay out of pocket

and be reimbursed, because by then the bill was already in collections and my

credit would've been shot by it.

>

>The thing that was finally successful: call the insurance company and file an

appeal, because the hospital is an approved hospital on my plan. I'm not sure

if it'd work out exactly the same way in your case, but I do hope you are able

to get them to cover it one way or another!

>

>~~

[Guest guest]

I have that caveat in my paperwork (ie-if your insurance doesn't pay me, the client will). If somebody crossed that out I would not take them as a client. I rarely take insurance and prefer instead to give people a superbill they submit to their ppos. Then the client gets reimbursed at whatever rates their insurance reimburses at and I get my full fee. Lindsey __________________________________________________

[Guest guest]

My insurance is an HMO and they are supposed to cover my visits to participating

providers. Whenever my primary doctor refers me to a specialist I always tell

them that I am crossing out the statement and they assure me that I am covered

and have no objection to my crossing it out.

Ora

>I have that caveat in my paperwork (ie-if your insurance doesn't pay me, the

client will). If somebody crossed that out I would not take them as a client.

I rarely take insurance and prefer instead to give people a superbill they

submit to their ppos. Then the client gets reimbursed at whatever rates their

insurance reimburses at and I get my full fee.

> Lindsey

>

> __________________________________________________

>