Here is a Blue Cross and Blue Shield Participation Update.
Note that Empire BCBS our local plan, has added a few new networks to their roster. We’re clarifying our participation status with these new plans.
Our office is not participant in the new:
- Empire BCBS Blue Priority
BCBS Blue Priority Sample Card
- Empire BCBS Pathway
- Empire BCBS Pathway Enhanced
- Empire BCBS Pathway X Enhanced
BCBS Pathway Sample Card
These plans have identification numbers preceded by YAZ, YCZ, QBP, JLB, JLF, JLC and BPR. There are other ID’s of which we have not been informed. Please consult with your insurance if you’re looking for participating providers. Please, confirm with any doctor’s office you call for an appointment, we find that the BCBS registry is often not accurate.
We ask our OUT OF NETWORK patients to pay at the time of service. Claim information will be provided to the patient for their own claim submission.
Re: Changes to our Financial Policy
As its prone to happen occasionally, we’re making changes to our financial policy. These come in response to the multiple changes to insurance policy coverage as well as the continuous shift in payment responsibility to our patients. As you as an insured party, may have become accustomed to, DEDUCTIBLES, CO-INSURANCE and CO-PAYS are commonplace and very high. To that end as of January 1st, 2018 we will require our patients to please provide a valid credit card to keep in their secure file. This credit card or debit card will be used once your claims are processed by your insurance and your responsibilities have been defined. This in turn will streamline our payment collection and billing. We hope, with your cooperation and understanding this will be a simple and painless task. We have amended our Financial policy to accommodate these clause. Additionally, a new form will be made available to you where you can fill in the pertinent information and sign your agreement.
Besides that, we have also made clearer some of our most common NON-MEDICAL fees, including our LATE CANCELLATION policy, fee for COPY OF RECORDS and LATE PAYMENT FEES. We hope once you review our amended policy you will see its simple to understand. You can follow this link for a copy. FINANCIAL POLICY
Thanks for your time,
The Billing Office
As we’re becoming more and more used to insurance company deductibles and coinsurance, we have to be even more aware of our medical expenses. Health care today is more convoluted and confusing than ever. One of the issues many patients are facing is the decision of seeing a doctor who is on staff at a hospital or hospital system as opposed to a doctor in private practice. As we have noticed in our area, many hospital systems are acquiring private practices. This is obviously to better their presence in their area and capitalize on the existing population of patients the private sector has. Health care is a business, we should all as patients understand and accept that. Now then, as we’re in the middle of receiving services, the provider (be it doctor or hospital) getting paid for said service and the insurance paying said services we need to be cautious about expenses as we would with any other goods or services we receive. Why are we mentioning this?
The truth of the matter is, when a hospital staff doctor sends a bill to the insurance he/she is billing their part plus a fee for the facility. By comparisson, when a private practice doctor bills for their services, they are billing only for their services, and normally they’re not allowed to invoice for the facility fees. As we understand it from multiple sources we have read a hospital’s invoice for facility fees when a patient is seen by their staff doctor at their office. The facility fee pertains the use of the hospital premises, staff and supplies. While this sounds like a logical fee for some, keep in mind the cost for your visit may be as much as 3 or 4 times higher than when you see a private doctor at his office.
Take a look at this article published by the ORLANDO SENTINEL:
While this article is now about 2 years old, it describes a practice and matter that is important for all of us to understand before we see a doctor. As it describes, even the same doctor who, last month was in private practice and today is a hospital staff doctor will show different fees for the same service. This may be true even if the doctor has not changed physical location. Please keep that in mind as some of these costs add up very easily and your portion will obviously rise with it. Ask about this before seeing your doctors.
This blog is in response to the following article:
LinkedIn.com Article – click here to read
In this article the writer goes over the the hurdles our healthcare providers go through to get paid for their day to day claims. Some of these hurdles are affecting our patient care adversely. In many cases even treatment plans are affected because insurance do not cover certain medications or procedures. This leaves our patient community in a healthcare limbo since the plan doesn’t “want” to pay for a service and the patient also does not want to be responsible. As the article goes on to indicate, many providers who were polled would like a single payer system. While we don’t necessarily agree with this assessment for our practice, we do believe our current healthcare hodgepodge helps only the health insurance community and not the patients or the doctors who render their services in good faith and in the best interest of our patients.
Our practice which has a large young and middle age patient population is plagued with the current HIGH DEDUCTIBLE issue. This means that our patients are responsible for the first $2000 to $5000 worth of medical services. In most instances patients don’t satisfy their deductibles before seeing one of our doctors. Many of them do not need that many services in a year. This causes a payment lag for the doctors services which in turn hurts the medical practice as a whole. Many patients are finding it hard to pay for medical services immediately once the claims have been processed.
Another issue discussed is related to the time and effort spent on trying to get the insurance plan to approve and pay for services and medications. This alone consumes several hours a week of the doctors’ and their staff. This time could be better spent caring for our patients. Add to that constant records requests and all sorts of questioning and second guessing the doctor’s judgement and yes, they go mad!
We’re interested in our patients and would like to see some progress in the healthcare machine that will put the patient’s health and the doctors’ efforts first. Our patients need care, our doctors need to be compensated for the care they provide. Web searches, deferred treatment and ER visits do not cut it. But thats the way things are going because of our current circumstances. Things need to improve.
Note that many plans require authorization for prescriptions. It seems that even commonly prescribed medications require it. Unfortunately, this way your insurance makes the process of providing you with your needed medications most time consuming. Insurance suggest that the doctor calls to obtain authorization. However, it is a most time consuming process. More often than not the doctors have several requests for pre-authorization at hand. Rather than making a call, our practice prefers to fill out a pre-authorization form. These are normally provided by your insurance and contain all information and/or questions pertinent to your particular prescription.
For that reason, if needed we ask you to obtain the required PRE-AUTHORIZATION forms from your PRESCRIPTION INSURANCE and have them forwarded to our office for the doctor’s review and fulfillment. This will allow the doctor to tend to the patients at the office as opposed to being held on the phone for several minutes a day jumping through insurance imposed processes.
Without the pre-authorization forms you will have to pay for your prescriptions out of pocket. Also, some plans have no coverage for certain medications. You’re welcome to have the insurance fax these to our main fax line:
PATIENT RESPONSIBILITY DISCLOSURE
As the new year goes on, our patients are being confronted with subtle changes in their insurance plans. Patient responsibility is newly assigned. Commonly, the new year means Deductibles reset and start again at zero. Many of our patients who had no deductibles in the previous year have them now. A large number of them are “not aware” of these changes and in turn it makes it more challenging to collect on these claims which are not paid by the plan since they represent patient’s responsibilities.
For that reason, we some time have to remind our patients that our participation with Insurance Plans does not imply you as our patient will not get a bill for services rendered during your visits or surgical procedures. Note that your Insurance Policy may have multiple ways to assign the responsibility of our fees to you. This is done through DEDUCTIBLES, COINSURANCE and COPAY. It is important to be familiar with these aspects of your plan to avoid unexpected bills and be able to manage your medical costs efficiently and effectively.
DEDUCTIBLES are assigned as per your policy to ALL SERVICES or just to CERTAIN PROCEDURES. Your insurance will not pay for your claims until the total of your deductible has been satisfied by assigning it to approved claims. These DEDUCTIBLES may range anywhere from a total of $200.00 per year to a total of $5000.00 (or more). Note, most often it will take several claims to satisfy a large deductible. As an example, if one visit claim for a patient was around $350.00 and the total deductible is more than that, then your claim for $350.00 may be payable by you, as per your plan’s provisions. Please be aware of this.
CO-INSURANCE is a percentage (%) of your total approved insurance claim which is billable to you as per your insurance policy. This varies widely through the insurance companies. A common CO-INSURANCE is 20% of the approved claim. Normally coinsurance is due after DEDUCTIBLES have been satisfied.
Additionally, a COPAY is a set amount (anywhere from $5.00 to $75.00 or more) collected from the patient at the time of the visit. This is usually stated on your insurance card. Some plans will specify different amounts for your General Doctor and for Specialists.
We hope this helps keep things clear.
One of the most common challenges for any practice during the beginning of the year is collecting in network deductibles (a set amount of dollars billable to the patient). Most insurance policy deductibles reset on January 1st every year. Many of our patients come to us early in the year, with that concern in mind. Medicare policies thankfully are simple enough, one deductible of $147.00 for the first claim or claims processed during the year.
For private insurance (Aetna, BCBS, Cigna, HIP, Oxford, United Healthcare) is a little bit more complicated. Private insurance deductibles are assigned in different ways, at times we wont know the specifics until a claim is processed. Some policies work like Medicare and deductibles are assigned to the first claim, regardless of the services on it. However, other policies are a bit more intricate and will assign deductibles based on type of service billed. Yes, patients have their booklets that inform them of potential deductible allocations however, this information sometimes is not detailed enough. Even when calling insurance to verify benefits, you wont know that while your policy will not have a deductible for your visit services, it may have it for medical procedures or for imaging services in the same date.
Its important for our patient population to keep in mind, that fees assigned to their Deductibles will be billed to them directly. We advise that they put aside some funds every year (some policies/employers provide Health Savings Accounts for that purpose) to address deductibles in their policies. This way those couple of hundred that might be billed to you will be easier to pay.
If you have any questions, please contact our billing office and we’ll go over your information.
Our office verifies all insurance policies for our patients. As we go over several accounts, the importance of up to date Coordination of Benefits becomes more apparent. We ask all our patients, new and existing to please provide us with ALL INSURANCE information. This includes our Medicare patients.
On occasion some patients ask “why are you asking for additional insurance? I use only this policy!” It’s important to understand that there are some rules in place when it comes to having multiple insurance policies. Unfortunately, even if we wanted to, as insured parties, we are unable to select which policy to use as primary insurance. When we have multiple policies insurance companies have methods in place to determine which of your policies should be your primary payer and which should be your secondary. These rules apply to all insurance companies and will have to be determined through all insurance policies a patient has. Once all insurance policies agree, then you have successfully setup your coordination of benefits and will know in which order to present your insurance information to your doctors. This process may be cumbersome, but once you have set your Coordination of Benefits correctly, you save yourself and your doctors a lot of future hassle.
One of the issues many practices encounter most often is related to patients who do not disclose all insurance information or were not aware of additional insurance coverage. These cases, while not many, tend to cause the most time-consuming problems from the administrative standpoint. That is without mentioning all the financial liabilities the patient may face. The problems arise when the one insurance the patient “always” used recognized their status as incorrect, after claims had been paid (some times a year after payment). Following this, the insurance would initiate payment recovery procedures with the indication “We paid your claim in error, the patient was insured by XXXXXX at the time of service, please invoice XXXXXX”. At this point it’s sometimes difficult to collect from the “correct” primary payer and we’re then obligated to collect from the patient.
When looking through the patient’s records we find that even though our forms request ALL INSURANCE be disclosed patients show only ONE CARD and fill in only ONE INSURANCE in their intake form. At this point we need to collect from the patient because either their other policy is one we don’t belong to or because it’s now too late to submit claims to another insurance because of timely filing constraints. In an easy case, the affected patient has just the one claim for the year. On an extreme case a patient would have received services from multiple health care providers during a time frame that could span more than a year, now with thousands of dollars to account for.
For this reason we insist that as an insured party, its important that you disclose all insurance information as well as be sure that your policies are correctly coordinated. This includes ALL PATIENTS. As mentioned before, its not our choice which policy is primary payer, our local laws and the insurance make that determination.