Practice Management Alert
Apply Contract Requirements to Orthotics, Too
Question: I work with a podiatrist who supplies custom orthotics for his patients. They cost $500. Several insurance companies allow the $500 fee whether the carrier covers the orthotics for the patient or not. However, UnitedHealthcare and Aetna only reimburse $118 for the orthotics. We have patients sign a waiver that they are fully responsible for the balance. They have the choice to not get the orthotics if they do not want to pay the balance. UHC told us we can't do that and that we have to accept its fees per our contract. Is there any way around this? New York Subscriber Answer: Unfortunately, your only option is to accept the reduced payment that UHC is paying you or terminate your contract with that carrier. Even though orthotics are supplies, not services, your contractual obligations still apply. By participating with a carrier, you-re agreeing to accept all of its fees, including surgery, services and supplies. Your doctor signed the contract and agreed to abide by the agreement he signed with UHC. What to do: You need to perform a financial analysis of reimbursements from the payer. You-ve already seen that you-re probably losing money on the orthotics supplies by participating with UHC. You may find that you-re also losing potential reimbursement on surgical procedures. Bottom line: You need to know your general costs of operation and decide what is best for your practice. You should consider dropping third-party payers that do not cover your costs and provide a reasonable profit. Keep in mind that you can have patients come to you out of network, and your revenue out of network will more than make up for the volume of work you may lose. You need to perform a cost/benefit analysis.
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