Direct payment by patients for anesthesia, then reimbursed later?

[g3pro]

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Hey everyone,

The other billing topic here gave me a thought: why don't anesthesia groups set rates themselves for their services? They have everything up front, full transparency, patients know what they're getting and what they're paying for, anesthesiologists know what they will be getting paid for every procedure, and the reimbursement part is rightly handled by the patient (they file the paperwork with the insurance company to get reimbursed for their expense).

Is this possible?

 

[core0]

Hey everyone,

The other billing topic here gave me a thought: why don't anesthesia groups set rates themselves for their services? They have everything up front, full transparency, patients know what they're getting and what they're paying for, anesthesiologists know what they will be getting paid for every procedure, and the reimbursement part is rightly handled by the patient (they file the paperwork with the insurance company to get reimbursed for their expense).

Is this possible?

You might end up giving up a fair amount of money. I'm not an expert on anesthesia billing but my understanding is that you get so many units for a procedure and so many units for time. So if you stated that it would be x amount and it took a lot longer then you are cutting yourself out of the money. Now if you want to say write me a check for $500 and I'll push propofol for your colonoscopy, that's already being done.

David Carpenter, PA-C

 

[huron]

Hey everyone,

The other billing topic here gave me a thought: why don't anesthesia groups set rates themselves for their services? They have everything up front, full transparency, patients know what they're getting and what they're paying for, anesthesiologists know what they will be getting paid for every procedure, and the reimbursement part is rightly handled by the patient (they file the paperwork with the insurance company to get reimbursed for their expense).

Is this possible?

That is how it works for self pay procedures like plastics.

For everthing else, Patients can't and don't know how to summit bills to their insurance companies. Insurance companies intentionally make billing as cumbersome and difficult as possible. So patient can't be expected to be able to get reimbursed for anesthesia procedures after they have paid you up front. Most people don't have any extra money laying around to pay expensive medical bills and then hope to get reimbursed three months later.

Insurance companies have set the rate for our services so if we bill for less than the rate that the company is willing to pay you are giving up money. You have to bill the same rate for all patients otherwise you are discriminating against some people, so typically rates are set at slightly higher than the highest reimbursed per unit rate in the area.

 

[Pilot Doc]

Although I don't disagree with your ultimate conclusion that directly billing pts for anesthesia isn't generally a good business strategy, I'd reach that conclusion for different reasons.

As for what you can expect from patients, it's a matter of supply and demand. If anesthesia services are scarce (and/or you're willing to collect aggressively) you'll probably be quite successful getting money out of patients regardless of what their insurance company does. But as you note, submitting bills for reimbursement is difficult and patients are unlikely to be completely reimbursed anyway.

Should you decide to bill patients directly, there's no reason you would have to conform to the current billing scheme of time + procedure code. You could do anything you want. And it's perfectly legal to have different prices for different patients. Some contracts (most notably Medicare) will prevent that, but you can choose not to participate.

As for Medicare - you don't have to participate. But you can't bill a patient unless they sign an acknowledgement beforehand that you aren't a medicare doctor. Between patient and surgeon pushback, I doubt this would be very successful.

 

[pd4emergence]

My group looked into doing this with just endos. The problem was that the major insurance companies in my state like medicare say you can't bill one of their patients directly or outside of thier contract and still be a provider for their company. So even if the service is not covered we were going to get into a fight with our major carriers for this set fee and it just was not worth it. Would I pay two or three hundred dollars for an anesthesiologist to do the sedation for my colonoscopy? Sure and there are a fair number of people that we take care of that don't meet inclusion criteria that would. But this is such a small part of our practice that it was just not worth the fight.