Website that provides insurance payment info based on e/m code?

[nexus73]

Is there a website that provides this information? Is it broken down by insurance, or just average of the region? And is it actually somewhat accurate?

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[dl2dp2]

Fairhealth estimates are generally reasonable. Ie my experience has been that if you use fairhealth estimates for OON pricing people won’t usually have sticker shock. And if your rates are below that you fill faster. For in network the numbers are reasonable estimates of revenue if you want to own a practice and borrow for salary etc.

 

[uhmocksuhsillen]

Fairhealth estimates are generally reasonable. Ie my experience has been that if you use fairhealth estimates for OON pricing people won’t usually have sticker shock. And if your rates are below that you fill faster. For in network the numbers are reasonable estimates of revenue if you want to own a practice and borrow for salary etc.

Can you describe what you mean by and borrow for salary?

 

[surfguy84]

Fairhealth estimates are generally reasonable. Ie my experience has been that if you use fairhealth estimates for OON pricing people won’t usually have sticker shock. And if your rates are below that you fill faster. For in network the numbers are reasonable estimates of revenue if you want to own a practice and borrow for salary etc.

I'm a new grad and starting a practice. I'm setting cash rates and also thinking of either going out of network with a couple payors or maybe trying to go in network.

I looked at fair health as you recommended. For a 99224+90833 in my area OON says 373+150. In network is 332+75.

Just a couple questions..

1. How common would it be to get these rates when I talk to the major payors in the area?
2. I'm thinking of setting my cash rates at 550 for news at 275 for follow ups. Am I underpricing based on the data on fair health?
3. These numbers feel kind of unrealistic. Two 99214 plus add on an hour would generate 800+ an hr in network. Can this be?

 

[KaiBuzz]

Many practices set their charges at 250%-300% of Medicare rates which can be found on the CMS website.

 

[surfguy84]

Many practices set their charges at 250%-300% of Medicare rates which can be found on the CMS website.

Hadn't heard that, thanks for sharing.

By that multiplier, a 99214+90833 should be priced $577-$693 in my area which seems absurd. I live in probably the top 2 or 3 highest cost of living locales in america..but even still, that seems crazy high.

A new intake would be $550-600 which seems reasonable.

 

[allantois]

Hadn't heard that, thanks for sharing.

By that multiplier, a 99214+90833 should be priced $577-$693 in my area which seems absurd. I live in probably the top 2 or 3 highest cost of living locales in america..but even still, that seems crazy high.

A new intake would be $550-600 which seems reasonable.

Look up what practices in your area charge

 

[reca]

The numbers for 90833 are specialty specific and I would say $75 is reasonable or on the lower side (though this is saying those figures are on the high side for your area).

$75 is the upper end of what insurance offers solo practitioners for a 90833. I've seen half of that.

 

[reca]

By that multiplier, a 99214+90833 should be priced $577-$693 in my area which seems absurd. I live in probably the top 2 or 3 highest cost of living locales in america..but even still, that seems crazy high.

Yeah, that's delusional. Getting a contract where 99214 + 90833 pays half of that would be considered excellent reimbursement rates.

If insurance was paying $1100-$1400 an hour, no psychiatrist would be doing a cash practice. Seriously, I feel like some people on here are completely out of touch with reality.

 

[surfguy84]

Yeah, that's delusional. Getting a contract where 99214 + 90833 pays half of that would be considered excellent reimbursement rates.

If insurance was paying $1100-$1400 an hour, no psychiatrist would be doing a cash practice. Seriously, I feel like some people on here are completely out of touch with reality.

In southern California I know reimbursement around 230 is common for a 214+833 for a solo practitioner. I've heard the further up the coast you go the higher it rises.

 

[hamstergang]

I support the idea of going onto websites of various psychiatrists in your area to see what they charge. While it might be obvious, I have found that those who post their rates online tend to charge less than those who don't put the numbers out there publicly.

I heard of one psychiatrist who secretly called other offices pretending to be a potential new patient just to find out their prices. I could never do this, but I'm sure some could pull it off well.

 

[clausewitz2]

I support the idea of going onto websites of various psychiatrists in your area to see what they charge. While it might be obvious, I have found that those who post their rates online tend to charge less than those who don't put the numbers out there publicly.

I heard of one psychiatrist who secretly called other offices pretending to be a potential new patient just to find out their prices. I could never do this, but I'm sure some could pull it off well.

Sometimes I feel like I could benefit from just a wee bit more callous/unemotional traits.

 

[KaiBuzz]

Just to clarify, depending on how competitive your market is, most health plans are paying 90% to 150% of Medicare for MD/DO services. Your charge master is really only applicable for self-pay patients.

Yeah, that's delusional. Getting a contract where 99214 + 90833 pays half of that would be considered excellent reimbursement rates.

If insurance was paying $1100-$1400 an hour, no psychiatrist would be doing a cash practice. Seriously, I feel like some people on here are completely out of touch with reality.

 

[dl2dp2]

I'm a new grad and starting a practice. I'm setting cash rates and also thinking of either going out of network with a couple payors or maybe trying to go in network.

I looked at fair health as you recommended. For a 99224+90833 in my area OON says 373+150. In network is 332+75.

Just a couple questions..

1. How common would it be to get these rates when I talk to the major payors in the area?
2. I'm thinking of setting my cash rates at 550 for news at 275 for follow ups. Am I underpricing based on the data on fair health?
3. These numbers feel kind of unrealistic. Two 99214 plus add on an hour would generate 800+ an hr in network. Can this be?

Hadn't heard that, thanks for sharing.

By that multiplier, a 99214+90833 should be priced $577-$693 in my area which seems absurd. I live in probably the top 2 or 3 highest cost of living locales in america..but even still, that seems crazy high.

A new intake would be $550-600 which seems reasonable.

Lol. Why don’t you try it and report back. If you tell people you price and nobody comes after you tell them, lower it.

My general experience in life is that when data contradict feelings, trust data more than feelings.

Corollary: large systems exploit you by at least 50% margin.

Third: main difficulty isn’t finding a customer who would pay, but to get a volume of inquiries.

 

[ObsequiousAplomb]

Yeah, I'd expect more like:

99215 at $150
99214 at $120
99213 at $80

90833 at $60
90836 at $100

99205 at $220

for most insurances in a major metro that isn't in CA or NY if you are a new solo private practice. I say that based on the rates I'm seeing as a new grad in solo private practice in the Mid-Atlantic region.

 

[clausewitz2]

Yeah, I'd expect more like:

99215 at $150
99214 at $120
99213 at $80

90833 at $60
90836 at $100

99205 at $220

for most insurances in a major metro that isn't in CA or NY if you are a new solo private practice. I say that based on the rates I'm seeing as a new grad in solo private practice in the Mid-Atlantic region.

For my neck of the woods that's low, think more $200-ish for 99214+90833. I am some hours from the coast, however, though not rural.

 

[surfguy84]

Yeah, I'd expect more like:

99215 at $150
99214 at $120
99213 at $80

90833 at $60
90836 at $100

99205 at $220

for most insurances in a major metro that isn't in CA or NY if you are a new solo private practice. I say that based on the rates I'm seeing as a new grad in solo private practice in the Mid-Atlantic region.

My residency city which was hcol city in the south was about 225 for a 99214 833.

 

[calvnandhobbs68]

Yeah, I'd expect more like:

99215 at $150
99214 at $120
99213 at $80

90833 at $60
90836 at $100

99205 at $220

for most insurances in a major metro that isn't in CA or NY if you are a new solo private practice. I say that based on the rates I'm seeing as a new grad in solo private practice in the Mid-Atlantic region.

Yeah this is pretty on mark. Highmark, which is the major BCBS insurer in NY, DE, WV and PA, actually straight up publicly posts their rates so anyone can google it and these are pretty close, slightly low for 90833.

Provider Resource Center

For the overall thread though, this has been said in other threads but this is highly region dependent. FairHealth is a pretty decent overall estimator but you won't be able to figure it out until you get fee schedules from various insurers. Cigna and Aetna are the lowballers around here, United is actually pretty decent for instance. This is totally flipped in other regions.