Happy Summer Holiday to you! I can’t believe the 4th of July has just come and gone. It’s been super busy here, so my apologies for not being in touch the last few months. Let's get right to it!
What’s happening in the world of insurance…craziness is happening is about all I can say. It’s getting harder and harder to get CORRECT information from carriers regarding benefits and claims and even harder getting a live person on the phone. Are you experiencing the same?
Let’s talk about some of these so called “rental networks” which we all know about. One network (which will remain anonymous) has been absolutely horrific to deal with. Historically they had one of the highest rates in the industry, so they were the “go to” for most of us. Now, the communication between their home base and the carriers signing into
their network has been almost non-existent, never mind trying to get ahold of them. I had a client that wanted to terminate from their network. The contract specifically had a clause stating that the termination would be effective at the end of the month that the termination letter was sent. To be fair, we sent the termination letter at the beginning of the month when we wanted to terminate. A month goes by, two months, three months, etc. and call after call is placed to the Professional
Relationship Department. Their response was simply “No one is manning the fax number that the termination letters go to. When someone has the time, we will process it as time allows”…Can you believe it? Is that not the craziest thing you have heard?
So, what is the take away on this? It’s to do your due diligence long before you want to either add or change contracts and make sure you have read the termination clause in the contracts. That said, did you know that some contracts require you to participate for 3 full years before you can terminate? Be sure to
collect as much information as possible regarding contacts, names, phone numbers, emails (not the generic one) when you’re ready to make a change and also, be kind to the people you are able to reach on the phone. They could be a life saver for you later on down the line!
Here's another tip: If you are struggling to get in touch with someone from an insurance carrier, try reaching out as a potential new provider. Ironically, the sales team is usually available, friendly, and happy to pick up the phone or return an email to someone new!
Lastly, before you decide to either terminate from and enroll in an insurance carrier, make sure the decisions are based on facts and not emotions. Run the appropriate reports in your software to determine the amount billed to a carrier and the number of patients you see with a particular plan. Do your research to determine how many carriers you
could potentially align with one signature (i.e. shared networks). If the carrier is part of several networks (direct, shared, partners, etc.) find out in advance which fee schedule you will be reimbursed by in your office. Some carriers will pay under their own fee schedule, others will pay under the lowest available…it’s worth your time to do the investigation to see what you are getting into.
As far as what’s coming next?... Lots of changes for CDT in 2023 and I will be highlighting some of those in the early fall so you are prepared and ready. As for updates on the NSA (No Surprises Act), I will delve more deeply into that in the next few months.
Until next time…Keep Calm and Code On!
