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Can I be on an insurance panel and not accept insurance?

SoCalTime

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Jul 30, 2017
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    Hello! I'm new to this forum, nice to meet all of you - thanks up front for reading this.

    I have an interesting question I have trouble finding a clear answer for. I'm starting my own psychiatry practice and do not want to accept insurance - I'm fortunate to be in a city where most psychiatrists don't accept insurance. I would like to work part-time for a hospital which has offered to get me on multiple insurance panels so I can see their patients.

    My questions is simple, and I must think many others have wondered the same. Can I be paneled on insurance companies for this hospital which is 45 min away from my practice, and still require out-of-pocket payments at my private practice if a patient happens to be covered by one of these insurance companies? Even Medicare?

    I've heard being paneled is location specific, which would lead me to believe the answer to my questions is Yes. But I could be wrong.
     
    D

    deleted480308

      Medicare is not location specific, if you are in you're in.....the only exception that I'm aware of is that medicare exempted docs can still get paid by medicare for treatment provided in an emergency setting
       
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      TexasPhysician

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        Very interesting re: medicare! So how do these academic inpatient and CL psychiatrists who run a cash practice on the side make it work? Maybe just advertising that you are out of network scares medicare patients away?


        It does not scare them away. You would have to outright refuse them in private practice and fire them when they obtain Medicare which drops your reputation in the community.

        Alternatively you have a group private practice where 1 person is solely private practice and opted-out of Medicare or just don't do inpatient/CL work at all. If you are lucky, find an inpatient gig where you take 0 Medicare patients.
         
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        thoffen

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          It does not scare them away. You would have to outright refuse them in private practice and fire them when they obtain Medicare which drops your reputation in the community.

          Alternatively you have a group private practice where 1 person is solely private practice and opted-out of Medicare or just don't do inpatient/CL work at all. If you are lucky, find an inpatient gig where you take 0 Medicare patients.

          Is that legal? I think you could find some practical way of doing that, but it doesn't sound right. Too bad Medicare doesn't let you be in network on a location basis.

          There was a thread here a while back on someone in this situation who was explicit about having a cash practice and their fees up front, and had a patient get service and then inform them they had Medicare and the provider would have to bill them instead of collect from the patient. I think they were stuck at least for the evaluation. Don't know if they could refuse future treatment.
           

          dl2dp2

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            Hospitals GENERALLY don't really care and their credentialing departments often don't check if you opted out of Medicare -- this bit I don't get at all. I'm guess they either 1) basically commit Medicare fraud, and then if Medicare audits one day pay a fine. People who opt out and bill Medicare is such a peanut that I suspect Medicare has bigger fries to pursue. 2) Take a hit and just don't care for the same reason. On occasion they do care, most likely due to the payer mix being a huge percent Medicare (i.e. geriatrics/nursing home etc). In these cases the job description often has it marked, and you should ask them if they care if you opt out when you apply for the job

            W.r.t. your private practice, in theory yes you need to verify that private patients don't have Medicare. In practice it is usually very clear from the get go. With Medicare patients who come to your practice, you need to have them sign a care agreement, as well as send CMS an opt out affidavit. The paperwork is searchable on CMS's website. If you don't opt out but also don't opt in, you can still charge the patient directly and he/her can feel free to directly file claims from CMS but it can't be above their limiting charge.
             

            SoCalTime

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              Thank you for all the helpful thoughts. Perhaps it won't be as much an issue since I wouldn't expect Medicare patients to be seeking an out-of-pocket psychiatrist in the first place. I happen to practice in a wealthy town. Do others with more experience find this to be true?

              Maybe I can be on all the insurance panels without complicating matters too much.
               

              TexasPhysician

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                Thank you for all the helpful thoughts. Perhaps it won't be as much an issue since I wouldn't expect Medicare patients to be seeking an out-of-pocket psychiatrist in the first place. I happen to practice in a wealthy town. Do others with more experience find this to be true?

                Maybe I can be on all the insurance panels without complicating matters too much.

                I have opted-out of Medicare and have plenty of Medicare patients paying cash. Those that have saved well for retirement do not want to wait months to see a psychiatrist just like everyone else.

                Getting on and maintaining panels complicates things 10 fold.
                 
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                Mad Jack

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                  Thank you for all the helpful thoughts. Perhaps it won't be as much an issue since I wouldn't expect Medicare patients to be seeking an out-of-pocket psychiatrist in the first place. I happen to practice in a wealthy town. Do others with more experience find this to be true?

                  Maybe I can be on all the insurance panels without complicating matters too much.
                  The trouble is, anyone over 65 that wants their social security benefits HAS to take Medicare, so 99.9% of your over 65 patients will have it. Even if they choose not to use it, you can land in hot water for treating a Medicare patient if you are a Medicare opt-in provider, even if the patient does not want to use their Medicare and you have mutually agreed not to accept it. So basically that leaves you unable to accept most patients over the age of 65 on a cash-only basis unless you opt out of Medicare completely.
                   

                  TexasPhysician

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                    Good to know. Thank you very much @TexasPhysician and @madjack

                    If I opted out of Medicare and were only on Medicaid, probably an easier path.

                    Strongly advise against taking Medicaid in most states. No one takes it in Texas, so they would flood your clinic with the lowest reimbursement rates. Accepting Medicaid here is only feasible with government subsidies.
                     

                    birchswing

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                      I have opted-out of Medicare and have plenty of Medicare patients paying cash. Those that have saved well for retirement do not want to wait months to see a psychiatrist just like everyone else.

                      Getting on and maintaining panels complicates things 10 fold.
                      I've not been able to see some doctors who are private pay because I have Medicaid as my secondary insurance. I have private insurance as my primary. They say that legally they can't see me because the law requires them to bill Medicaid. But I wonder if it's different for Medicare?
                       

                      VA Hopeful Dr

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                        I've not been able to see some doctors who are private pay because I have Medicaid as my secondary insurance. I have private insurance as my primary. They say that legally they can't see me because the law requires them to bill Medicaid. But I wonder if it's different for Medicare?
                        State dependent
                         
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