Insurance

[ChristineS]

Hello all. I am writing to see if anyone can help me out. I have a client that would like to fax me a list of carriers that he is contracted with. From that he wants me to research and find out what other carriers in his local area are holding allot of clients. 90% of his pts are ref. from the carriers he currently works with. He is interested in finding more carriers in his area to contract with. I hope that all made sense. My question is this. Does anyone have any ideas on how to find out such info other than calling similar specialties and seeing what carriers they work with? Also how should I go about charging my client to do the research and for offering him the info? Any averages I should stay between?
Thanks 

[thatcuteblonde]

First off, be careful about what contract your client signs, especially with small companies such as First Health/Coventry or Empower Chiro. These types of companies discount everything from United Healthcare (regardless of your contractual status) to Workers Compensation claims which could be losing your client up to 75% on many claims.

Most major insurance comanies have a provider directory and you can enter the specialty and zip code to get a list of par providers, even some of these subnetworks have sites like this but remember there are clauses in many of these contracts that allow these 'networks' to give the same discount to another network your client is not contracted with.

For example, Private Health Care Systems bought Multiplan which means if you are contracted with Multiplan you are obligated to discount all united healthcare claims, and as a non par provider you only get aprx 60% of their 'R & C".

[PMRNC]

You also have to be careful, doctors are not to discuss fee schedules with other doctors as it is MOST likely written in their contract that they are prohibited from doing that. The proper way is to obtain credentialing packets and fee schedules from the carriers and compare them to your in office fee schedule. In some cases you will need to write the carrier with your LOI (Letter of intent) to obtain a fee schedule and others will not let you have the fee schedule until you fill out a preliminary app (non binding) and disclosure (so that you don't discuss the fee schedule with other colleagues)