Author Topic: Need clarification on BCBS par plan  (Read 6375 times)

ChiroPay

  • Newbie
  • *
  • Posts: 3
Need clarification on BCBS par plan
« on: January 21, 2009, 02:46:27 PM »
We are currently in BCBS Par plan.
The plan initially 4 years ago was to go in network with BCBS.
We applied twice and got denied twice. I have left us in the par
plan for the last 3 years. We are not in any other networks.
I am evaluating as to whether it it beneficial to us to stay in the par plan.
I don't see any benefits to stay in the par plan. In fact I like the idea
of being out of network. A little bit less control via the insurance carrier.
 
A few questions.
 
1    If you are in the par plan is the patient considered out of network?
2    If we remove ourselves from the plan we were told the check would go the   
      patients.
      We already have electronic deposits setup with BCBS.
3    Does BCBS pay more if you are out of network versus the PAR agreement.
4    What is the advantage of the par plan?
5    What would you do?
I appreciate, if any body can help me in this regard.
Thank you for your help.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: Need clarification on BCBS par plan
« Reply #1 on: January 22, 2009, 06:35:15 AM »
Hi,
   I'm alittle confused by your question.  When you state you are 'in the par plan' to me that is saying that you are in network, but you are saying it as if you are out of network.  So I'm going to answer your questions the best I can.  If I missed them, please let me know.

1.  It is the provider who would be considered out of network, not the patient.  The patient is considered to be going out of network if they see an out of network provider.

2.  Many times if a provider is out of network the check will go directly to the patient.  It varies from carrier to carrier, but usually goes to patient.

3.  All BC plans vary as well.  Some will have a higher allowance for out of network, but in my experience it is usually the same allowance or lower.

4.  The advantage to being in network is that the check/payment comes to the provider, and patients don't like to go out of network (in most cases).  Then they have to be responsible for payment and their out of pocket costs are higher.

5.  It is hard for me to tell you what to do.  I know with my experience with BCBS with chiropractors that it is better to be in network.  Most of the plans in this area allow the same for out of network but the payments go to the patients.  If they are out of network the provider is only getting $30 for a visit, and they have to make the patient pay.  Most patients will go to an in network provider especially since with BCBS there are plenty of them.

Good luck with your decision.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

Pay_My_Claims

  • Guest
Re: Need clarification on BCBS par plan
« Reply #2 on: January 22, 2009, 07:07:15 AM »
I thought I had double vision at first on this question, but he is in another forum with me. We had the same ? about what he meant by par plan, and answered the questions accordingly. Working as a nonpar DME biller, I have had several experiences where the check has gone to the client. Before I came there they had a client take the check because he was the policy holder, and was divorced from his wife. His son got a pwc from our company, and he lived with his mom. His dad took the check, we went to court but he only paid 100. I sent him to collections and eventually got the money for the business, but it was a mess. We unfortunately can't become a par provider since BCBS of NC has closed is acceptance of any Dme vendors. They also have funky rules about submitting cost that is hectic.

Amit_Nischal

  • Newbie
  • *
  • Posts: 15
Re: Need clarification on BCBS par plan
« Reply #3 on: July 14, 2009, 03:07:45 PM »
Per my perception:-

1. If you are in the par plan is the patient considered out of network? No.

2    If we remove ourselves from the plan we were told the check would go the   
      patients. We already have electronic deposits setup with BCBS.

Usually, insurances pay directly to patient if provider non par and in this case you can bill patient for bill. But it also depends on type of carrier's protocol.

3    Does BCBS pay more if you are out of network versus the PAR agreement.

The only diffrenence is being non par provider, you have complete right to collect the whole charge amount from the patient.

4    What is the advantage of the par plan?

Big advantage is that billing patient being non par provider may cutdown on the # of patient's visiting clinice/office. As most of patient do not like to pay for the bill when they have policy. So, better to be partipating provider.

5    What would you do?

If i would been at your place, should have taken that contract with the insurance.

Hope you have answers to all your questions.

Thanks,
Amit

PMRNC

  • Hero Member
  • *****
  • Posts: 4252
    • One Stop Resources & Networking for Medical Billers
Re: Need clarification on BCBS par plan
« Reply #4 on: July 14, 2009, 03:24:54 PM »
BCBS will not honor assignment of benefits for non par providers. There might be one or two states that were challenging this but I'm not sure about the status of that.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Pay_My_Claims

  • Guest
Re: Need clarification on BCBS par plan
« Reply #5 on: July 14, 2009, 05:38:39 PM »
BCBS will not honor assignment of benefits for non par providers. There might be one or two states that were challenging this but I'm not sure about the status of that.

BCBS OF NORTH CAROLINA Will not pay to the provider if you are non-par and as Linda stated will not honor the aob. It's not as bothersome if you have small claims, but I am now in pursuit of a claim payment sent to a client in excess of $28,000. We have 2 payments (just 2 clients) that are $37,000 both BCBS of NC. If it is the State plan, they will send payments (go figure), but the PPO, and Fed plans don't.

My receivables for this DME provider is high anyway. Wednesday I posted 82,000, Friday was 36,000 and Monday was 110,000. Today (whew-just notification of about 50k that has been cut to pay thus far). Doing my daily job, and having to chase a client for a check, is overwhelming at time. I wish BCBS of NC would open the panel for new DME providers.

PMRNC

  • Hero Member
  • *****
  • Posts: 4252
    • One Stop Resources & Networking for Medical Billers
Re: Need clarification on BCBS par plan
« Reply #6 on: July 14, 2009, 07:35:45 PM »
Charlene, Can you have the patients sign an ROR? That would obligate the patient to sign the check over to you guys. There are a few state guidelines you have to check to do this but ask your client to consult with their attorney for a good formatted ROR (Right of Recovery)  A good friend of my dad's is a surgeon and he uses this for high dollar claims BECAUSE of BCBS.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Pay_My_Claims

  • Guest
Re: Need clarification on BCBS par plan
« Reply #7 on: July 15, 2009, 08:46:50 AM »
Charlene, Can you have the patients sign an ROR? That would obligate the patient to sign the check over to you guys. There are a few state guidelines you have to check to do this but ask your client to consult with their attorney for a good formatted ROR (Right of Recovery)  A good friend of my dad's is a surgeon and he uses this for high dollar claims BECAUSE of BCBS.

Hey, Thanks, I didn't even think of that!

PMRNC

  • Hero Member
  • *****
  • Posts: 4252
    • One Stop Resources & Networking for Medical Billers
Re: Need clarification on BCBS par plan
« Reply #8 on: July 15, 2009, 09:18:05 AM »
I didn't either it just hit me because you have mentioned this before!  It's worth looking into :)
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

SamatNMBS

  • Newbie
  • *
  • Posts: 1
    • National Medical Billing Services
Re: Need clarification on BCBS par plan
« Reply #9 on: March 02, 2012, 11:36:06 AM »
Does anyone have a Right of Recovery letter they can share?

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: Need clarification on BCBS par plan
« Reply #10 on: March 06, 2012, 06:38:03 AM »
I avoid collections!  I don't have a sample, but the following website has many sample letters:

http://www.collectionagencyservices.net/collectionletters/samplecollectionletters.html
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com