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   RE: asking payment and NOT billing insurance even if we're contracted
 From: Peter Liepmann
 To: Member Forum
 Posted: 08-06-2017 15:54
 Message: It depends.

For both, I'd recommend you collect at TOS and give them info to submit.  Here's why:

  1. If your #1 patient is assigned to another primary, you might not get paid for the visit.  What if they have wrong ins info, etc?  Give them a superbill  and let them wrestle with THEIR insurance co.
  2. Since MCR doesn't cover the visit at all, the secondary could balk.  If the patient submits directly they don't have to say anything about MCR. (Other ins is primary.)
  3. Naturopaths??

Peter Liepmann MD FAAFP MBA
My mission is to fix US health care
Bakersfield CA
Original Message:
Sent: 08-05-2017 12:11
From: Melissa Weakland
Subject: asking payment and NOT billing insurance even if we're contracted

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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