Medical Billing Forum
Billing => Billing => : luc September 03, 2013, 06:32:50 PM
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Hi. I just opened up a practice and am doing research on billing. I signed a contract with an insurance company and discovered that they pay way below my usual rate. Now I know I signed the contract, and that is binding. I get that. My patients understand this discrepancy, too, and some are willing to pay the difference, which is great, of course. But I don't want that to turn around and bite me. Is there a waiver that they can sign that will keep me safe?
Luc
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Hi. I just opened up a practice and am doing research on billing. I signed a contract with an insurance company and discovered that they pay way below my usual rate. Now I know I signed the contract, and that is binding. I get that. My patients understand this discrepancy, too, and some are willing to pay the difference, which is great, of course. But I don't want that to turn around and bite me. Is there a waiver that they can sign that will keep me safe?
Absolutely, positively NOT. you accepted their fee schedule and to collect from the patients any difference aside from THEIR policy out-of-pocket would be considered fraud.
If you are that unhappy you can hire a good consultant with a background in contract/fee-schedule negotiation and you might be able to negotiate rates, it realy depends on many variables.
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Linda answered the question perfectly.
I was just typing the same thing :)
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Glad I asked. I have tried to negotiate myself (can't afford anything else), and the fee was raised only five dollars. I'm thinking I just need to opt out of the contract and go out-of-network, but I don't know what the repercussions might be. Is there anything I need to be aware of regarding opting out, like penalties, risks involved in re-credentialing at a later time, etc? I'm in a rock/hardplace situation.
Thank you
Luc
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Glad I asked. I have tried to negotiate myself (can't afford anything else), and the fee was raised only five dollars. I'm thinking I just need to opt out of the contract and go out-of-network, but I don't know what the repercussions might be. Is there anything I need to be aware of regarding opting out, like penalties, risks involved in re-credentialing at a later time, etc? I'm in a rock/hardplace situation.
Thank you
Luc
If you opt out and go as out of network, you may lose patients. They tend to go to in network providers because that is less the patient has to pay out of their pocket.
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Do a complete carrier analysis and write off adjustments for that carrier. Also run a patient report by carrier to see the volume of patients with that carrier/plan.
You also want to look at your contract termination terms. I've seen some BCBS carriers sneak a 2 year out clause in there.. :-[ :o
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Gotcha. I'll familiarize myself with your terms and get on that (not sure what a carrier analysis or report by carrier is). I sure do thank you all for your assistance. Dreams are coming true :)
L
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not sure what a carrier analysis or report by carrier is).
Your practice management software should be able to give you reports so that you can analyze your patient volume and revenue by that particular carrier, so that you can see if it's efficient to get out of your contract.