is it true that some health insurance do not reimburse doctors for OMM?

[hottie]

I interviewed this DO and he mentioned that he does nto always get proper reimbursement for the OMM, so he was discouraged to practice OMM.

What do you guys know about this topic? 😕

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[Biodude]

I've heard that DO's charge up front cash for performing OMM rather than getting reimbursed from insurance companies because some of the companies don't really look at that as acceptable medical treatment.

 

[allendo]

I've heard that DO's charge up front cash for performing OMM rather than getting reimbursed from insurance companies because some of the companies don't really look at that as acceptable medical treatment.

Well they reimburse chiropractors

 

[tkim]

The question of insurance reimbursement is more complicated than whether or not they will pay for OMM.

Different insurance companies have differing reimbursement policies. Some include OMM as part of the office visit, and therefore will not pay beyond the office visit reimbursement. Others view it as a PT procedure and reject it based on that.

The fact is that there are ICD-9 codes specifically for OMM, and that makes those procedures billable.

Don't fall into the idea that because OMM is an osteopathic treatment that insurance companies will deny them more often than other treatments. Many procedures are denied all the time by insurance companies, and physician's offices battle constantly with insurance companies for reimbursement. My insurance company used to routinely deny payments for lab tests, procedures, etc. It's about cost-savings to them.

The flip side of this issue is that some people seek out OMM and pay cash for it. So much so, that, I've met some physicians who do a cash business for OMM and do quite well.

 

[Taus]

Billing for OMM is around 75% of the DO's practice that I currently shadow. I am in awe of how he works, as he commonly spends 30mins with every patient, while both assessing all of their health needs and performing OMM. He makes the same as a Doctor who would see 4 patients an hour because of the way he is paid, which is for a normal consultation and OMM (twice the cost for a visit). Patients only need to pay one copay for a visit, but their insurance pays double the amount back to the doctor of a normal visit. His billing office is run by a former DO school's head of billing and he has no problems collecting. I should also mention that he only works 4 days a week for a total of 30 hours a week and makes a very comfortable living.

 

[hottie]

your responses are interesting.

does this issue depends on region where you practice? the DO I spoke to practices in 😕 California.

 

[Taus]

Not sure.....but I'm in NY....

 

[swaamedic]

to get reimbursment depends on the pt's health insurance, thus u either do or don't get paid. In phoenix I know the Dr I was with got $75 from health insurance companies if they paid for it (which appeared to be most). If not u can either do it for free or bill them (dependent on time spent) to get reimbursed 3 areas of the body must be examined and charted thus: somatic dysfunction in cervical, thoracic, lumbar would get reimbursed as they are considered 3 different areas.

 

[carn311]

Billing for OMM is around 75% of the DO's practice that I currently shadow. I am in awe of how he works, as he commonly spends 30mins with every patient, while both assessing all of their health needs and performing OMM. He makes the same as a Doctor who would see 4 patients an hour because of the way he is paid, which is for a normal consultation and OMM (twice the cost for a visit). Patients only need to pay one copay for a visit, but their insurance pays double the amount back to the doctor of a normal visit. His billing office is run by a former DO school's head of billing and he has no problems collecting. I should also mention that he only works 4 days a week for a total of 30 hours a week and makes a very comfortable living.

Where is this doctor located??? I'm in new york state and am having a heck of a time finding a DO to shadow...

 

[Taus]

I don't want to put his info on here, as I'm sure he doesn't want to start getting tons of phone calls about this.... But anyway, if you call up NYCOM and ask them they will absolutely help you find a DO to shadow.

 

[Dr Alo]

Billing for OMM is around 75% of the DO's practice that I currently shadow. I am in awe of how he works, as he commonly spends 30mins with every patient, while both assessing all of their health needs and performing OMM. He makes the same as a Doctor who would see 4 patients an hour because of the way he is paid, which is for a normal consultation and OMM (twice the cost for a visit). Patients only need to pay one copay for a visit, but their insurance pays double the amount back to the doctor of a normal visit. His billing office is run by a former DO school's head of billing and he has no problems collecting. I should also mention that he only works 4 days a week for a total of 30 hours a week and makes a very comfortable living.

I agree with the above. In the right part of town, and if your patients have privae insurance, like Blue Cross Blue Shield... you will not only get paid... you will really get PAID!!

 

[ambernikel]

I agree with the above. In the right part of town, and if your patients have privae insurance, like Blue Cross Blue Shield... you will not only get paid... you will really get PAID!!

I think it all depends on the ins company. I've had several different insurances and some pay well and some don't. My docs have always just sent me a bill if they didn't pay out and then let me know for the future. But I haven't had anything like that happen in about 5 years.

I agree, it's like anything else with insurance companies. A constant battle to get the patients the treatment they need.