Question
I have recently had a few patients whose insurance includes hearing aid benefits. The insurance claims department tells us to submit our usual charges. They will reduce my charges to my contracted rate and pay 80% of that, not to exceed a certain amount. They won't tell me what the contracted rate is for any of the codes. How do I know if my reimbursement is going to be acceptable if they don't have to tell me up front what they've decided they'll pay?
Answer
You won't know, you can't know and you'll not be able to determine if it's acceptable or not! Why in the world, as business person, would you EVER accept this insurance?
My bet is that you'll also be looking at very SLOW pay too, since this insurance company is putting you in a no-win situation.
My approach? If you want to fit the patient and the patient wants to work with you, require that they pay the costs of treatment up front, and require them to seek reimbursement from their company. Insurance carriers are much more likely to be prompt with their subscribers than they are with you.
Make sure that the patient signs a waiver that says they are responsible for the balance should you end up accepting this insurance in a moment of weakness. It's the only way to do it.
Dr. Ken Smith has been in private practice since 1976 in Overland Park, Kansas. He is a past president of ADA and teaches Basic Business Skills in the PCO Au.D. program. He can be reached at kesmitters@aol.com.
Kenneth Smith, AuD
Past President Academy of Dispensing Audiologists
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