In network fee schedules

[mandrew]

I was curious as to what other pods around the country are getting from their participating insurance plans for commonly billed codes such as 99213 or 99203. Thanks for your replies.

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[Feli]

I would suggest against this... specifically says in most insurance contracts not to share/discuss attached or associated fee schedules.

If you don't see that on yours (or you're just asking due to considering starting/buying own office), I can try to image capture the language in some of mine a diff day. But yeah... no bueno, even grounds for dismissal from eligibility with the payer's family of plans (MCR, MCA, PPO, HMO, etc etc).

 

[heybrother]

My contracts all essentially say do not share. However, all of our fee schedule data is also posted online in massive machine readable (unreadable) pentabyte files. The insurance companies are required to share all of this data due to price transparency rules, but they've essentially made it as difficult to access as possible. The only people who can get into the files are university researcher types who do health policy. There's a website out there called Turquoise Health that tries to acquire hospital fee schedule data to post online. I actually had a conversation with an insurance company exec about this.

The question that you might be wondering though is - yes, E&M is underpaid. What I mean by that is that most major insurance companies did not take the 2021 Medicare change into account. Additionally, if a contract is "really good" - the multiplier for CPT will always be better than the multiplier for E&M.

 

[mandrew]

I would suggest against this... specifically says in most insurance contracts not to share/discuss attached or associated fee schedules.

If you don't see that on yours (or you're just asking due to considering starting/buying own office), I can try to image capture the language in some of mine a diff day. But yeah... no bueno, even grounds for dismissal from eligibility with the payer's family of plans (MCR, MCA, PPO, HMO, etc etc).

Thanks, I will check one of my contracts if I can find one.