Seeking advice from people currently doing cash practice

[Psychguy1990]

This message board has been a wealth of information for me so far. I have read several old threads regarding psychiatrists here that have done cash based practices.

I am graduating this upcoming June (CAP fellow) and plan to start a small cash based practice (one day a week) that I hope will grow over time and can be my full time job eventually. While I get my practice going I plan to take a part time job to supplement my income. One of the jobs is at the VA, which would make things simple as they would not require me being paneled with any insurance. The other is a position that would require me being paneled with private insurance, but not not Medicare/Medicaid.

I know that based on searching old threads that people have stated that if you have a second job from your private practice where you are staff and you are paneled with private insurances, that your are only paneled with that specific location and under their tax ID. After speaking with some of my attendings who have their own private practices (cash based) they have stated that insurance companies can still give you trouble with telling some patients that you are in network with their company with your private practice (even though you aren't, since your private practice has a separate tax ID and NPI). As a result of this some of their patients have run into issues with getting out of network benefit reimbursement from them.

Is this an issue that anyone on here has run into in their private practices (assuming you are paneled with another job that you are working on the side)? If so how did the situation turn out?

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[Sushirolls]

Not your problem.
If you are OON doing cash, and the patient submits to insurance themselves, that's their fight. They get the thrill of dealing with insurance.
How the insurance company opts to authorize or reimburse them for OON services isn't your problem.
I'm not surprised the insurance company might try to say you are some how still in network, and only reimburse that... because it might be lower cost to to them then an OON rate. Just depends on the company and how they set up the OON vs IN rates.

At most provide a superbill. Beyond that, don't wade into the insurance deep end... massive time suck. Just don't.

I have a 0.5 FTE assistant with my insurance based practice and most of her job is claims processing and sleuthing out where things went wrong. Next up is patient inquiries, and onboarding.
Next up is chasing down OOP expenses from patients. [I'm not diligently getting all upfront like @randomdoc1 does. Some day I might be as awesome]

 

[TexasPhysician]

Insurances will do anything to not pay. This isn’t my problem in my cash practice.

 

[comp1]

Tangential, but I've actually had an excellent experience with my (admittedly premium) insurance reimbursing on superbills. It's obviously not everything, but it is something. Hopefully the OP provides those. I know it's hard to market that because it's probably confusing to the average consumer that if you have a PPO...you still likely have SOME coverage with a cash provider.

 

[clozareal]

Sometimes the insurances make you submit a W-9 or a form to be an out of network provider (why do they make those who aren't in their network complete forms??).

Sometimes they send payments to your other/previous employer thinking you are in network. You need to list your EIN/TIN clearly on your superbill and make sure the patient requests that it's billed under the EIN/TIN rather than your NPI.

Sometimes they send out of network payments to your other/previous employer which is annoying. I had to contact a previous employer to get that check voided. The patient tried but failed to get any traction. A new check was cut to the patient after a month or two.

It's a drag. Most of the time it's fine but once in a while patients get their payments delayed because of it.

It won't stop me from doing my private practice though. Working out financial kinks is just part of the business.