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insurance networks

 
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insurance networks - September 14, 2005 9:05:00 AM   
KIDPT23


Posts: 228
Joined: May 21, 2002
From: Illinois
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My wife and I are starting our own practice and came across the issue of trying to get into insurance networks. There are so many different carriers and trying to get into them has been a huge headache thus far. Anyone have any suggestions????
Post #: 1
Re: insurance networks - September 14, 2005 1:59:00 PM   
drbuddy

 

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Joined: July 31, 2005
From: Pennsylvania
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Keep everything organized, very organized. Keep a separate log for each company. Note when you send your request for applications, when you send the application, any phone conversations, etc. In the beginning, I picked one day of the week, every week, to call asking about the status of my applications. I think it was Aetna that lost/never recieved my application twice. third time I sent it and finally it went through, 4 months after I initially applied.

Make sure you follow up often or they WILL forget about it or put it to the side until they want to deal with it.

If you arent sure what insurances are in your area, either talk to a collegue, an MD's office, or chiro office and ask what insurances they see most often. You can also call local factories and businesses with lots of employees and ask what health coverage they offer.

(in reply to KIDPT23)
Post #: 2
Re: insurance networks - September 14, 2005 3:13:00 PM   
Sean Weatherston

 

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Joined: August 4, 2005
From: Idaho
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First off, start now! I don't know when you plan on opening, but start downloading and sending for applications right away. Most of them will want pretty similar information so the sooner you can round it up, the better.

I agree with buddy in that it's a great idea to ask around for the major insurers in your area and keep track of all your conversations.

The one other thing I would strongly suggest is to double, triple, and quadruple check your applications to make sure everything is correct. If they have a chance to kick something back, they will-- don't give them the opportunity.

Good Luck!
Sean, PT, OCS

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Sean Weatherston, PT, OCS, CSCS

(in reply to KIDPT23)
Post #: 3
Re: insurance networks - September 14, 2005 8:00:00 PM   
Colonial1672

 

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Joined: September 14, 2005
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Try CAQH.org and Apperture

It was very helpful for me. Check it out. Once you fill out the information it will submit the information for you.....see the details for yourself.

Ralph

(in reply to KIDPT23)
Post #: 4
Re: insurance networks - September 15, 2005 10:29:00 AM   
KIDPT23


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From: Illinois
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Anyone used PTPN????

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Re: insurance networks - September 15, 2005 12:02:00 PM   
coloradojulie

 

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From: colorado usa
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I have avoided middle men contracting like the plague it is! Contact the provider relations reps for each company that uses PTPN or Theraphysics and request a direct contract. Otherwise the cost to join these networks, although it seems like an easy way to get multiple contracts at the outset, is really high.

Don't be afraid to negotiate your rates. Often you will be offered a percentage of set values, like the Medicare fee schedule or the workers comp schedule for your state. Think of it like buying real estate...they lowball you etc. Even 5-10% above the initial offer is in the long term money in your pocket. It won't scare them away....

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PRC

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Post #: 6
Re: insurance networks - September 16, 2005 7:57:00 AM   
KIDPT23


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From: Illinois
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It will be a long time before we get into networks on our own.If we use a company like PTPN then we will be in many networks quickly. What are some suggestions that will allow us to see patients if we are not in their insurance company network?? Can we see them as they are in-network and write off the difference??? Can we not see these patients at all??? If we cannot see these patients, the referral sources will not be satisfied with us.

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Post #: 7
Re: insurance networks - September 16, 2005 7:45:00 PM   
coloradojulie

 

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From: colorado usa
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You can see these patients as out of network, and you are not obligated by any contract rates. You set your price and whatever the insurer pays the patient pays the difference. There are no contract allowances etc. as you have not signed any. Generally speaking you will get less out of network, and the patient will have to pay a greater portion.

I think legally you have to watch writing patient portions whether you are in network or not. The insurance company has a contract with the patient that they will pay a certain percentage....if you consistently bill a high amount and write off the rest, the company is now paying 100% not something they agreed to.

Rather offer a discount for services paid up front and let the patient submit to their insurance company and get reimbursed. Once you are contracted with a company though, you are obligated to collect copays or deductibles and to accept contract discounts. Again routinely writing these off would be in breach of contract because the insurance company is now paying 100% but also will send a message to the company that they are overpaying you...and they may cut your contract rates, and all the rates for all the other PTs in your area. You must watch what precedence you set.

In my experience, the more you discount your services the less it is respected and the more people believe you are overcharging them in the first place. A firm financial policy sets a professional tone with no confusion.

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PRC

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Post #: 8
Re: insurance networks - September 18, 2005 8:06:00 PM   
Augustine5I

 

Posts: 28
Joined: April 12, 2004
From: NJ
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I have used CAQH and apperture with good success. It is free of charge and helps speed up the process.

Always check the clients out of network benefits before you turn them away. Sometimes the client has a small deductable........sometimes not. After you know the details you can talk to the client and maybe work something out.

Unfortunately, many people are afraid/hesitant to go "out of network".

Although the process of getting into network with the insurance companies can be long and tedious.......keep plugging away one at a time. No one starts off taking every insurance. Sometimes the insurance company has "closed" its panel and puts a freeze on new providers. You just have to be patient.

Some advice. Look at your competition. Try to get into network with some insurance companies they don't take......even if you get less from a not so good insurance company, you will still be building "work of mouth" referrals and advocates in the community to help your business grow.

Also, be good on following up on the insurance companies credentialing department. Call almost every week. You don't want your application stalled b/c a W9 is missing. I even had a company loss my entire application.


Good luck,

Tom

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[URL=http://www.colonialpt.com]www.colonialpt.com[/URL]

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Post #: 9
Re: insurance networks - September 20, 2005 2:29:00 PM   
KIDPT23


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From: Illinois
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If you are not contractually bound to the insurance company, do you have to collect the out of network co-pays???

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Post #: 10
Re: insurance networks - September 20, 2005 9:31:00 PM   
drbuddy

 

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Joined: July 31, 2005
From: Pennsylvania
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I havent seen out of network "copays", but usually it is co-insurance. In otherwords, if you are out of network and the patient pays you 100 bucks, the insurance company will cut the patient a check for 80 bucks (assuming 20% co-insurance and assuming your $100 charge is usual and customary).

If you are submitting the bill for the patient, than that means you are automatically agreeing to certain terms, such as collecting all necessary copays.

(in reply to KIDPT23)
Post #: 11
Re: insurance networks - September 23, 2005 12:16:00 AM   
pwrandall

 

Posts: 72
Joined: May 15, 2004
From: Sonora, CA
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The APTA's website has a really interesting position statement on non-collection of co-pays that essentially suggests if you don't collect you may be committing fraud (prosecuted by the feds as mail fraud, not by the company you committed the fraud against. Scary.

PETE

(in reply to KIDPT23)
Post #: 12
Re: insurance networks - October 9, 2005 11:11:00 AM   
Nicole Matoushek PT MPH CSHE CEES

 

Posts: 797
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From: St. Petersburg, FL
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I agree with the statements aabove, joining a PT network provides discounted therapy prices, but they usually pay upfront or within 30-45 days, and although the prices are lower, they in effect do marketing for you to save you on your marketing costs/resources. But, read your contract carefully, there are terms and clauses in there and you want to make sure you understand how you are being reimbursed, in addition, some networks have appeals processes or utilization management that may also affect your reimbursement. Provider contracting is an artform!

If you need any help with specifics, feel free to contact me directly.

Nicole Matoushek, MPH, PT, CEES, CSHE
[URL=http://www.ergorehabinc.com]www.ergorehabinc.com[/URL]

_____________________________

Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com

http://www.ErgoRehabBlog.com

http://www.ComputerAccessoriesOnlineStore.com

(in reply to KIDPT23)
Post #: 13
Re: insurance networks - October 10, 2005 10:21:00 AM   
Soleman

 

Posts: 64
Joined: March 13, 2000
From: USA
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It is illegal to routinely waive patient co pays and co insurance per the US dept of Health and Human Services.

(in reply to KIDPT23)
Post #: 14
Re: insurance networks - November 6, 2005 10:01:00 PM   
mgcali

 

Posts: 16
Joined: August 8, 2005
From: Los Angeles
Status: offline
I have a couple of questions for anyone who may be able to help:


1) Do you need a federal tax id number BEFORE you apply for insurance contracts?

2) Is a fed tax id number all you need for Medicare?

3) Is it easier to contract with companies if you accept Medicare?

4) Is it ever possible to have contracts switched over into your name? ie you work at a private clinic and want to open your own - can you call them and say you're no longer working there but want to keep a contract with them?

5) In private practices, does each PT need to have a contract to bill for services, or can just the owner have the contract and then bill other PT's services under their number?

Thank you so much in advance. I have found this forum to be quite helpful and informative.

~ Melissa

(in reply to KIDPT23)
Post #: 15
Re: insurance networks - November 7, 2005 11:22:00 AM   
KIDPT23


Posts: 228
Joined: May 21, 2002
From: Illinois
Status: offline
1) Yes and a medicare number. You will need to get the forms from the individual companies ahead of time so that you know what to expect in the paperwork.
2) You also need to show proof of a current license as well in the state you will operate in.
3) Policies will vary from state to state as far as contracting with companies, but one thing is most important, who gives the companies the best rates.
4) When doing that make sure that all ties with your current employment are done, then approach the companies you want to keep ties with and try to establish a contract with them. Tread lightly with this tho,you never want to burn any bridges or have someone in the community talking bad about you. Remember most marketing and most referrals are from word of mouth.
5)If you open as a rehab agency then the company will have a universal number that all services will be billed thru and one medicare number. A rehab agency is actually a part A Medicare facility that bills thru a Part B plan. Very long and tedious to get into(usually 4-8 months) and very strict policies(red bagging, lots of policy and procedures, etc..)If you are going to bill for O.T. or Speech, then you have to open as a rehab agency. If you are only to have Outpatient P.T. then you don't have to be an agency. The private insurances usually follow the lead of Medicare. Work Comp. allows you to set up individual contracts with each business and allows you to be creative with what services you will be offering. Please feel free to email me with any other questions. I have just opened a new facility about a month ago so I have just went thru all of this. nymba@go.com good luck!

(in reply to KIDPT23)
Post #: 16
Re: insurance networks - November 7, 2005 12:57:00 PM   
Nicole Matoushek PT MPH CSHE CEES

 

Posts: 797
Joined: January 16, 2005
From: St. Petersburg, FL
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That is good stuff KIDPT! Thanks for sharing your experience!

_____________________________

Nicole Matoushek, PT, MPH, CSHE, CEES
http://www.ErgoRehabinc.com

http://www.ErgoRehabBlog.com

http://www.ComputerAccessoriesOnlineStore.com

(in reply to KIDPT23)
Post #: 17
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