Private Insurance Q&A-Private Insurance Q&A Recording

Video Transcription
Video Summary
Welcome. I am Dr. Claire McGorry, the moderator for this evening's private insurance Q&A webinar. Our panel of speakers includes Scott Craig and Drs. Erika Johannes, Rosemary Rogoty, and Alex Vaughn. We are unable to discuss fees or insurance reimbursement amounts due to antitrust laws. The AADSM does not endorse any services or products mentioned during the webinar. Opinions expressed during the webinar are solely those of the individuals expressing them and not that of the AADSM. The webinar is dedicated to question and answer sessions. The first question addresses determining a patient's financial responsibility for appliance therapy with commercial insurance. The panel suggests using mathematical calculations involving deductibles, copays, and allowable charges. Software tools, such as Excel spreadsheets or specialized software, can assist in the calculations. The panel also discusses the importance of obtaining benefits prior to the patient's visit and the possibility of obtaining a predetermination from the insurance company. The next question pertains to the time limit on sleep studies for insurance or Medicare requirements. The panel clarifies that Medicare does not have a specific time limit, but timely documentation is preferred. Other insurance companies may have their own policies, and it is recommended to check the local policy for each insurance company. The panel advises that a sleep study within the last 12 months is generally preferable, but outside of that timeframe, it would depend on the specific policies of each insurance company. Another question asks if it is legitimate to charge a cash fee to patients and not submit the claim to their insurance carrier, particularly in light of rising deductibles. The panel responds that it is legitimate to charge a cash fee with the patient's permission, as long as the fee is reasonable and there is full disclosure with the patient regarding insurance coverage. However, it is essential to have written authorization from the patient to ensure compliance with HIPAA regulations. The next question inquires about the advantages and disadvantages of being in network with large commercial insurance companies. The panel explains that being in network allows for easier billing and certainty about reimbursement rates. The volume of patients may increase with in network status, but it may also mean lower profit margins due to lower reimbursement rates. The decision to be in network or out of network depends on an individual business analysis. The pros and cons of using a third-party biller are discussed. The advantages include expertise in billing, while the disadvantages may include a higher cost and less familiarity with the specific practice. The use of in-house billing allows for greater control over the billing process, but may require a significant investment of time and resources to ensure expertise. The final question addresses fee-for-service arrangements and whether claims need to be submitted to patients. The panel agrees that submitting claims for patients may increase doctor referrals, but it is important to assign the benefits to the patient to avoid any financial liability. Preauthorization requirements depend on each insurance company, and it is necessary to check with the specific company regarding their policies. Overall, the decision to submit claims on behalf of patients depends on the specific situation and preferences of the provider.
Keywords
private insurance
Q&A webinar
panel of speakers
fees
insurance reimbursement
antitrust laws
services
products
AADSM
opinions