Staying Independent...Together

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   RE: asking payment and NOT billing insurance even if we're contracted
 From: Cindi Croft
 To: Member Forum
 Posted: 08-10-2017 16:25
 Message: Hi everyone.
I am so sorry have been so distant.
I am feeling so overwhelmed.

But I did want to chime in on this thread.
I have read all my contracts since I just opened in Feb. & they all allow for what is termed “non-covered service fee” can be collected from patients.
I did call all my provider reps. and clarified this.
So read your contracts for you may be able to collect an annual fee in addition to accepting the contracted insurer rates.

Cindi Croft, DO

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

1.  I have to agree with Jeff although I haven't read my contracts in years.  My memory of my contracts is they are all about payment and contracted fees.  That is what the contract is.  You are not allowed to charge more than the contracted fee schedule, you can not collect directly from the patient anything other than their copay and then only what the insurance company says they are responsible for.  You can not balance bill.  I would be shocked if your contracts don't mention payment.  I don't know what else they would mention.  (well other than those quality indicators and time to wait for appt, etc)

2.  This one is trickier.  All participating and non-participating physicians must bill Medicare electronically.  Only those who opt out, or who do even have an option to opt-in are excluded from this (like your partner).  But patients can't bill Medicare to my knowledge.   And you can't bill a secondary without the rejection from the primary.   If this is a supplemental plan, it won't be covered.  But if it's a secondary insurance, like from a spouse or retirement plan, it should be billable, except for that little problem that you can't get a rejection from Medicare.  I'm wondering what your partner's school teaches about how to handle this.

On another issue, Melissa, my daughter is on the path to become a naturopath.  She is applying to schools this fall.  She would love to be able to "talk" with your partner about what it's like to be a practicing naturopath, especially in a state that has one of the least restrictive licenses and allows insurance participation.  Also, with you on how it fits in with allopathic medicine.

Kathleen Saradarian, MD
Branchville, NJ

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