Wiki Payment to Patient questions

Create Wiki
C

Cavalier40

Guest
Messages
136
Location
Stuart, FL Sailfish Chapter
Best answers
0
Hi all

I am new to AAPC and I have been searching the forums for an answer to this, but I have not been able to find it. So I decided I should just ask.

As an out of network provider, are we powerless to get self funded insurances to pay to the provider even with an assignment of benefits? I know in the state of Florida, we can apply our assignment law to cover group insurance plans, however I am at a loss for self funded plans. They tend to hide behind ERISA.

I work in substance abuse and the worse thing for a patient who is clean for 40 days is to all of a sudden find a checks in the mail in excess of 20K. Also many clients have no money coming in and have to work out payment plans for their patient responsibility so payment up front is not a viable option.

Now since Value Options has gone pay to patient (for Empire plans at least) this causes a huge and confusing headache both for us and our patients.

Any help would be greatly appreciated.
 
the only suggestion I have is to look at the payers' contract. Is it that your providers are not par because some plans do not view their specialty as a payable one? Or do they choose not to par because of low reimbursement? I wish i had a better suggestion for you.
 
the only suggestion I have is to look at the payers' contract. Is it that your providers are not par because some plans do not view their specialty as a payable one? Or do they choose not to par because of low reimbursement? I wish i had a better suggestion for you.
 
This is a very touchy subject and one that calls for creative solutions. I suggest working with an attorney to make sure the wording is appropriate, but this is one instance where a credit card on file type arrangement can be helpful.

Sadly, this situation often turns into a repeat visit to the facility.
 
As an OON facility we usually contact the family members immediately and begin a rapport with them if we know the plan will be non assignable. About 95% of the time we end up having the checks sent to us. The other ones we refer to our attorneys.
 
You must log in or register to reply here.
Top