best private insurance reimbursement

[liquidshadow22]

Thinking about opening a private practice and starting with paneling with 1 or 2 private insurances. Any tips on which ones typically provide the best fee schedules for psychiatrists?

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[TexasPhysician]

Fee schedules can vary by practice size, negotiation skills, state, county, city, and even side of the street. If only I were joking.

 

[liquidshadow22]

Yea that's what I have heard as well. So i was just thinking of calling aetna, United, cigna, bcbs and just picking one or two. Is that a good approach or should i try broaden my sample size?

 

[randomdoc1]

For my practice: anthem blue cross, Aetna, Cigna, Humana, and medicare.

United actually pays us worse than Medicare. Fortunately they just about all pay reasonably. But with United I had to do some hardcore negotiations because as a small practice they really tried to screw me over with Medicaid rates for all United plans. I fought for six months and they gave me a not too different rate from anthem. I think people confuse Medicaid with Medicare. Medicaid is the one that pays poorly. But at least in WI Medicare pays pretty decent.

I’d recommend anthem blue cross, United and medicare. Those three make up 75% of my panel. And they pay decent. It’s actually also good to take Medicare due to the very low deductible and patient responsibility. Then you know you will get paid reliably. A lot of people carry high deductible plans so unless you collect at time of service, you’ll be chasing down a lot of people to pay their bill. Also, with Medicare, if someone has a supplement insurance and met their deductible, insurance will pay you 100% of the cost. If you go commercial only, patient has to meet max out of pocket, which is at least several thousand in healthcare bills for their insurance to pick up 100% of the tab and it resets every calendar year.

 

[liquidshadow22]

Does medicare always fully pay whatever is listed in their fee schedule with CPT codes?

 

[randomdoc1]

Does medicare always fully pay whatever is listed in their fee schedule with CPT codes?

It is approximately a $198 deductible, which is teeny compared to the $1000-$10000 deductibles on commercial plans. After that Medicare pays 80% of the cost. The remaining 20% is either paid by the patient or their supplemental insurance. Most of my patients after they met their deductible, their insurance/s picked up the whole tab. That was the case if I billed 99213/99214 with add on psychotherapy.

 

[finalpsychyear]

It is approximately a $198 deductible, which is teeny compared to the $1000-$10000 deductibles on commercial plans. After that Medicare pays 80% of the cost. The remaining 20% is either paid by the patient or their supplemental insurance. Most of my patients after they met their deductible, their insurance/s picked up the whole tab. That was the case if I billed 99213/99214 with add on psychotherapy.

Hi. In my area medicare pays 70 for level 3 and 104 for level 4 EM visit meaning the total allowable charge and 20% of that you get from patients directly.. I only have one insurer that pays above these rates besides a few out of network ones which i am not counting. All the other ones pay in the range of 60-67 for a level 3 and 80-90 for a level 4. United only offered medicaid rates which in my area is like 40 and 55-60 for a level 3 and level 4 visit i quickly passed. Not sure how you negotiate as a single provider other than refusing their rates and forcing them to pay out of network which is what i have done and those rates provided the deductible and sort is met are higher than any in network by a factor of 1.5 to 2. Sometimes you can do single case agreements if patients switch insurers from one you took to one you don't. I wish medicare was the minimum payment like it was 20-25 years ago. Oh well.

 

[clausewitz2]

Hi. In my area medicare pays 70 for level 3 and 104 for level 4 EM visit meaning the total allowable charge and 20% of that you get from patients directly.. I only have one insurer that pays above these rates besides a few out of network ones which i am not counting. All the other ones pay in the range of 60-67 for a level 3 and 80-90 for a level 4. United only offered medicaid rates which in my area is like 40 and 55-60 for a level 3 and level 4 visit i quickly passed. Not sure how you negotiate as a single provider other than refusing their rates and forcing them to pay out of network which is what i have done and those rates provided the deductible and sort is met are higher than any in network by a factor of 1.5 to 2. Sometimes you can do single case agreements if patients switch insurers from one you took to one you don't. I wish medicare was the minimum payment like it was 20-25 years ago. Oh well.

I am actually just speechless, those rates are hot steaming garbage in this market. The two big payers are consistently 15ish percent above medicare, and medicare pays 140 for 99214+90833.

 

[finalpsychyear]

I am actually just speechless, those rates are hot steaming garbage in this market. The two big payers are consistently 15ish percent above medicare, and medicare pays 140 for 99214+90833.

Right but your including the add on code. I was posting just the office visit L3 or L4 for comparision. Still thats great you have 15 percent higher for 2 biggest payor. The only thing i have is most patients are private with small copay and none of these high deductible plans.

 

[nexus73]

Right but your including the add on code. I was posting just the office visit L3 or L4 for comparision. Still thats great you have 15 percent higher for 2 biggest payor. The only thing i have is most patients are private with small copay and none of these high deductible plans.

resurrection time. Just saw a commercial insurance paying $141 for a 99214 and $72 for 90833