for docs who have completed their residency

[aggiecrew]

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[erichaj]

I wish it was that simple.

To answer your question, Every Insurance company is different. this question needs to asked from every one of them.

You can make a contract with anyone you want, the question is how much room will you have to negotiate. With some insurance companies the answer is very little. With all the others, the answer is a little more.

EH.

 

[neilc]

if you are a provider for the insurance, you get paid whatever they agree to pay you. if it is a co-pay deal, you keep the co-pay, and get reimbursed at the ins company's rates for office charges. if it is a 90/10, the patien pays 10% and the insurance co pays 90% of the agreed charges.

if you do a cash practice, you charge what you want. the insurance reimbursment to the patient (if there is any) is between the insurance company and the patient.

 

[aggiecrew]

if it is a 90/10, the patien pays 10% and the insurance co pays 90% of the agreed charges.
QUOTE]

when you say agreed charges, are you saying that they invidually negotiate each 90/10 contract with every doctor in their network?

thanks!

 

[neilc]

if it is a 90/10, the patien pays 10% and the insurance co pays 90% of the agreed charges.
QUOTE]

when you say agreed charges, are you saying that they invidually negotiate each 90/10 contract with every doctor in their network?

thanks!

they typically have set charges for a geographical region, similar to what medicare has...

an insurance company must limit the exposure they have...there is no way you are going to get a company to agree to pay 90% of whatever the doctor feels he wants to charge.

the basics are pretty straightforward...either you are a provider for the insurance, and accept the rates they decide to pay you, or you are cash and the patient pays you and gets what he can back from insurance. many practices are providers for some insurances, and take cash from everyone else. some are straight cash. some are HMO (basically you get paid a flat rate to take care of the patients (capitated) much like a salary).

i would not get too worked up about it. who knows where the future may lead you....but, you can build a practice anyway you want. it is just a matter of getting the patients in the door.