Insurance coverage changes for 2010

BackBenders
Whoa...

Insurance changes
If you are reading this you may have received a notice from us regarding your insurance coverage. We have had many claims return with information relating to changes in coverage, provider status, and IPA participation.

Commonly we get a referral from an insurance company that is later denied, or the insurance company will pay and then request the payment be returned because they have determined the patient was not covered after all.

According to industry 'buzz', copayments will rise, deductibles will rise and reimburesement will decrease... 'Since the new insurance laws and other legislations have been enacted things are bound to get worse before they get better.' I have been keeping my ears perked and eyes open for any changes that are afoot.

What has happened.
Our office is contracted through a select few HMO's (Health Maintanance Organizations. e.g ASHP, ASHN, Landmark, and Family Care Speciailists) We have had to unsubscribe from a number of others over the last year because it is not financially feasable to stay on. They require too much paperwork and offer too little reimburesemt (pay) to keep us in business. (E.g. ACN, Pacificare, Great West, Secure Horizons, United Health care)

Here are the things to know for this office.

If you are on an HMO, and you don't need a referral, you have a limited number of available visits. It doesnt matter what your policy says... We have to request authorization for visits (usually after the 8th for the year). Your policy may say 20 visits per year. In thirteen years of practice I have had only two patients that received that many and that was a fight and a half!

If you have an HMO and need a referral, you are better off going cash, I have never received a referral that worked... Unless it was Workmans Comp.

If you have an EPO, PPO or other program that allows you to choose your proivider, excellent. But we will bill you for deductible, patient responsibility, and any other amounts not paid by your coverage.

If you have a Personal Injury Case (slip and fall, car accident) where there is a third party paying or on lien... You are ultimately responsible for the bill, What your attorney tells you is between you and the attorney. Our agreement with you is we provide service you pay for service. Although, we may negotiate a different settlement for you on a case-by-case basis.

In the end, nothing stays the same. Your insurance can and does change frequently without notice to us or to you. We attempt to bill insurance as a courtesy. If you feel your bill should have been paid by insurance, feel free to pay the amount due to our office and contact your insurance provider for reimbursement.

Keep well, naturally.

Dr. Sean