Insurance Payouts

[ironmaidenrules]

Advertisement - Members don't see this ad

Quick question for those in the know. I was wondering what is the averge payout for a first office visit for your normal outpatient family practice with no labs or proceedures?

Private Insurance--
Medicare--
Medicaid--
Cash pay--

I know that the amount billed is going to be much higher than the payout I just wanted to know how much the doc is getting back.

thanks

 

[deleted87716]

There's no "normal" or "average." Reimbursement will vary from contract to contract even in the same geographic area. There's tremendous variability from state to state and payer to payer. Physicians are prohibited by law from disclosing their negotiated fees with payers (anti-collusion legislation and all that), so I can't tell you what I get, nor can anyone else.

Medicare's fees are available here: http://www.cms.hhs.gov/PFSLookup/

Most commercial payers will reimburse in excess of Medicare's rates, although they'll also be more than happy to screw you if you aren't paying attention and just blindly sign up without any sort of scrutiny or negotiation.

New patient visits, if appropriately coded, generally reimburse higher than established patient visits, although not always by much.