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
Related Courses
1https://www.audiologyonline.com/audiology-ceus/course/understanding-privilege-for-healthcare-professionals-36096Understanding Privilege, for Healthcare ProfessionalsSystems of privilege have created a wide division of inequality. This course will help hearing care professionals identify their privilege and determine how to make a difference in their places of employment.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comUnderstanding Privilege, for Healthcare ProfessionalsSystems of privilege have created a wide division of inequality. This course will help hearing care professionals identify their privilege and determine how to make a difference in their places of employment.36096OnlinePT60M
Systems of privilege have created a wide division of inequality. This course will help hearing care professionals identify their privilege and determine how to make a difference in their places of employment.
2https://www.audiologyonline.com/audiology-ceus/course/creating-leadership-in-audiology-through-37632Creating Leadership in Audiology Through a Mentoring CircleThere are so many components to quality patient care that it is challenging to “master” them all. What if you could come together with other professionals who possess knowledge or experience that could help you or your practice? There are a number of veteran audiologists as well as rising professionals who have wisdom, qualifications, narratives, and unique journeys to share. The purpose of this talk is to rethink the traditional mentor/mentee vertical relationship and explore collaboration in the form of circle…where all professionals, regardless of age or experience, learn from each other.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comCreating Leadership in Audiology Through a Mentoring CircleThere are so many components to quality patient care that it is challenging to “master” them all. What if you could come together with other professionals who possess knowledge or experience that could help you or your practice? There are a number of veteran audiologists as well as rising professionals who have wisdom, qualifications, narratives, and unique journeys to share. The purpose of this talk is to rethink the traditional mentor/mentee vertical relationship and explore collaboration in the form of circle…where all professionals, regardless of age or experience, learn from each other.37632OnlinePT60M
There are so many components to quality patient care that it is challenging to “master” them all. What if you could come together with other professionals who possess knowledge or experience that could help you or your practice? There are a number of veteran audiologists as well as rising professionals who have wisdom, qualifications, narratives, and unique journeys to share. The purpose of this talk is to rethink the traditional mentor/mentee vertical relationship and explore collaboration in the form of circle…where all professionals, regardless of age or experience, learn from each other.
3https://www.audiologyonline.com/audiology-ceus/course/using-patient-reported-outcome-measures-35841Using Patient-Reported Outcome Measures (PROMs) to Improve Patient-Clinician Communication and Enhance Treatment EfficacyDue to the recent increased focus on providing patient-centered healthcare, use of patient-reported outcome measures (PROMs) have become an essential component of assessing whether the services provided improved patients’ health and sense of well-being. This course will discuss the role of PROMs in healthcare and how using these measures in clinical practice can enhance treatment efficacy, improve patient-clinician communication, and assist clinicians in providing better person-centered care.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comUsing Patient-Reported Outcome Measures (PROMs) to Improve Patient-Clinician Communication and Enhance Treatment EfficacyDue to the recent increased focus on providing patient-centered healthcare, use of patient-reported outcome measures (PROMs) have become an essential component of assessing whether the services provided improved patients’ health and sense of well-being. This course will discuss the role of PROMs in healthcare and how using these measures in clinical practice can enhance treatment efficacy, improve patient-clinician communication, and assist clinicians in providing better person-centered care.35841OnlinePT60M
Due to the recent increased focus on providing patient-centered healthcare, use of patient-reported outcome measures (PROMs) have become an essential component of assessing whether the services provided improved patients’ health and sense of well-being. This course will discuss the role of PROMs in healthcare and how using these measures in clinical practice can enhance treatment efficacy, improve patient-clinician communication, and assist clinicians in providing better person-centered care.
4https://www.audiologyonline.com/audiology-ceus/course/salary-negotiations-32770Learn to Earn the Salary You Deserve: Negotiating Like a BossThe ability to negotiate your income displays immediate knowledge and confidence in your skillset and worth. In this course, we will examine a revenue and pay justification method to put into place as audiology business owners, employers, and employees.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comLearn to Earn the Salary You Deserve: Negotiating Like a BossThe ability to negotiate your income displays immediate knowledge and confidence in your skillset and worth. In this course, we will examine a revenue and pay justification method to put into place as audiology business owners, employers, and employees.32770OnlinePT60M
The ability to negotiate your income displays immediate knowledge and confidence in your skillset and worth. In this course, we will examine a revenue and pay justification method to put into place as audiology business owners, employers, and employees.
5https://www.audiologyonline.com/audiology-ceus/course/core-topics-for-audiology-assistants-37123Core Topics for Audiology AssistantsThis course includes one hour of content on each of the following topics: 1) ethical concepts and decision-making; 2) universal safety precautions, including the Occupational Safety & Health Administration's (OSHA) bloodborne pathogens standard, and 3) patient confidentiality and the Health Insurance Portability & Accountability Act (HIPAA).auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comCore Topics for Audiology AssistantsThis course includes one hour of content on each of the following topics: 1) ethical concepts and decision-making; 2) universal safety precautions, including the Occupational Safety & Health Administration's (OSHA) bloodborne pathogens standard, and 3) patient confidentiality and the Health Insurance Portability & Accountability Act (HIPAA).37123OnlinePT180M
This course includes one hour of content on each of the following topics: 1) ethical concepts and decision-making; 2) universal safety precautions, including the Occupational Safety & Health Administration's (OSHA) bloodborne pathogens standard, and 3) patient confidentiality and the Health Insurance Portability & Accountability Act (HIPAA).
