Staying Independent...Together

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   RE: asking payment and NOT billing insurance even if we're contracted
 From: Jean Antonucci
 To: Member Forum
 Posted: 08-06-2017 10:32
1 If you have a contract with  payer you have to  use it yes?I mean what if the patietn did  come to you to establish then hated you and  never came back? All the sameNo you  have a contract  so you cannot charge some onetime fee
2 I dunno

 3 there is no easy way except not to take insurance Insurance sucks
Again  though, I tell you, I have a biller     I do not  see most of this    I  spot check  things I wonder about( did we get paid for X,and I will follow through some things )  I look at eobs sometimes mostly I refuse ,it upsets me.  I tally in my head what I should take in and translate it to annual income In general MORE comes in that I think will.     All this stuff does is cause  agitata   Does anyone really really think docs are DOING this minutia? I talk to docs who say Z00.00 and do not  list the hypothyroidism etc for the prev. exam  i t  is too much trouble
I  am  not going to leave money on  t he table- I  do bill for the stoopid 3.00 urinalysis ( THIS WEEK MY U/A CANISTER AND MY PREGNANCY TESTS WERE STOLEN  FROM MY OFFICE) but frankly I cu tmy losses Bill for stuff see another patient and move on. I am sometimes going to bat for things Other times I am thinking it is not worth 100.00 to  wrangle t o get 35.00
I long ago stopped  billing for FOBT cards I lose money if I do them   I lose more  money if I bill

     Jean Antonucci MD
     115 Mt Blue Circle
     Farmington ME 04938
ph 207 778 3313   fax 207 778 3544

------Original Message------

Two different situations both related to collecting payment at the time of service and not billing insurance for a patient visit even though we are contracted with a particular insurance.

It seems like an area of many opinions but no consensus if I'm breaking any rules.
I can't find anything in my actual insurance contracts addressing this.

1. a non-established patient calls and needs an urgent same day appointment (a friend of patient, relation from out of town etc). They do have insurance with whom we contract but aren't planning to establish care with us. Is there anything wrong with us not collecting their insurance information and charging a one time out of pocket fee for the visit?   We provide them with claim information if requested if they want to bill the insurance on their own.

2.  A patient with medicare.  I am contracted with medicare and bill them. My partner is not contracted and cannot bill them. He is a naturopath and given a federal insurance system, they do not recognize his license.  When anyone establishes at our clinic with medicare, they sign a form and it clearly states that for visits with me I bill, but visits with Jonathan, they will have to pay out of pocket.

A patient has  a secondary that Jonathan can bill to.  Are we obligated to do the extra work to bill to that insurance for visits with him or can we still ask a patient to pay for out of pocket? They could of course still submit on their own if they so desire.

I'd also love to hear if you have a creative systems you're using to be able to continue to take insurance for the sake of our patients but make it less onerous within your own system.  That is really all we're trying to do-  find middle ground and be creative to keep it working for us all.

Thanks. Melissa

Melissa Weakland MD
Ballard Neighborhood Doctors
Seattle WA
IMP since 2007

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