Once you become contracted with various insurance carriers, there are many pieces of working with insurance that you must keep in mind as a provider to make it worth the effort. You automatically agree to the contracted rate or physician fee schedule with the carrier per your contractual agreement, that stipulates how much they will pay you for each particular service that you provide. Although, there are other fees that you want to make sure you also collect so that you are not just leaving money on the table. You want to make sure you are collecting; co-pays, co-insurance and deductible amounts upfront before providing any services to the patient. These are all the direct financial responsibility of the patient(s). Below is a short description of each: Co-pays - the dollar amount a patient must pay per their policy for seeing a specific provider. This amount usually varies from $5 to $50 depending on the practice type and of the policy outlines. It may be zero too. Co-Insurance - this is the percentage that the patient is responsible for of the cost of services provided. This amount normally ranges from 10% to 40%, although it could be more. A policy that pays 100% is fully covered and therefore there is no co-insurance. This may also be covered occasionally by a second policy, if the patient has multiple policies. Deductible - this is the amount the patient must pay out of pocket prior to the insurance carrier willing to cover any cost of services provided. This amount can range from $150 up to $5000 or more, depending upon the patient's policy. So for example, if your cost of service is $200, then a possible breakdown for total reimbursement for the cost of service may look like such; Provider Rate from insurance = $40 Co-pay from patient = $20 Co-insurance from patient (20%) = $20 Deductible ($100, with $60 already met) = $40 Total Reimbursement = $120 Based on this example, you can see that you actually receive more than half of what your services cost. The objective of working with insurance is definitely a numbers game though; so you have to average out how many patients you would need to see based on an average of reimbursement obtained to make it work the effort. Yet, the key may very well be making sure you collect ALL of the money due to you, from the insurance and the patient directly! |
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CategoriesHealth Insurance PoliciesHealthcare Updates Medical Billing and Coding Medical Credentialing Medical Practice Strategies Medical Pratice Financial Strategy Mental Health Providers
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