Author Topic: Healthcare Insurance Groups/Networks?  (Read 1194 times)

AdvancedSpine

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Healthcare Insurance Groups/Networks?
« on: January 04, 2012, 05:36:20 PM »
I work at a Chiro's office and we have decided to accept major medical patients starting this year.  When I called Aetna they said doctors from my are have to sign up to a network or group of doctors in order to participate.  I have no clue where to start looking for one or what good ones are out there.  I'd really appreciate some guidance.  Thank you.

DMK

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Re: Healthcare Insurance Groups/Networks?
« Reply #1 on: January 04, 2012, 05:56:20 PM »
First and foremost, be sure to find out what all is affected when you join a "group".  Where we are, in order to become a Blue Cross Provider, you have to join the ASH Network.  For most plans it's not a problem, some plans require pre-approval for treatment from ASH.  Then once you are an ASH member some CIGNA plans require that you send the claims to ASH for pricing.  It's messy, time consuming, rate reducing, and I have a difficult time getting my questions answered sometimes.  However, it's the price you pay for being on their provider list and patients picking you because you accept their insurance.  I grit my teeth and figure it out because it's good business to accept any insurance you can.

Optum is a fairly easy network to deal with.  United HealthCare uses them for some of their plans.

Health Net is another ok plan.

The most important thing is to realize that in joining some of these networks you agree to have some of your work comp fees cut and some of your PI case fees cut.  If the insurance company is part of the network and you are part of the network, you agree to the reduced rates.  It's not much of a cut, but it is a cut. 

So, read the fine print, and read the list of insurance companies in the network.  Then let the doctor decide.

AdvancedSpine

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Re: Healthcare Insurance Groups/Networks?
« Reply #2 on: January 05, 2012, 04:54:48 PM »
Thanks for your help!