M 14 Superbills For Insurance In A Cash Pay Model

a doctors perspective minisode 14 justin trosclair

Should you give your patients a superbill or file for them out of network when doing a cash practice? Can you back bill the remainder of charges? I also cover how to handle “do you take my insurance

Okay, welcome back to a doctor’s perspective, today we’re talking about cash PT lunch hour and number 17 with Jerry Durham from San Francisco.

 I’m telling you I have such an appreciation for construction workers it makes me think of back in the day when my New York City you know, this black and white artwork where they’re building these gigantic skyscrapers hitting these massive cranes they got these little guys on top of these tall buildings they’re building an add on to this train station I’m at right now blow torches on the middle you know triangle shape structures and these Popeyes they’re just sitting there perched hanging out relax, and other guys are welding and the cranes are moving up and down carrying stuff is just blows my mind like the way things are built. And these massive buildings are still had to be built. One screw by one screw, you know one way to one world crazy.

Now today’s show is all about calm was the basics of insurance and like running a cash practice for pts. You know, it’s kind of a new thing, these conversations, we have a lot of chiropractors. So here’s the breakdown. First defining your patient is your customer, not yourself and not your insurance.

Because you get to the point where you can look at a patient now they only were 30 bucks from insurance, I’m not going to be the same that I would do for someone who’s paying 150 cash. And if you start noticing yourself acting that way of being that way, obviously, that’s a gut check. And now I’d be time to say hey, maybe I should just go all cash because I’m not treating the patient the same, and not getting the care that the patient deserves, which is who I want to make happy everything for the patient.

And that’s where this guy, Jerry’s USP is unique selling proposition is creating a happy patient.  And so he noticed his numbers like, we need to make X amount per visit based on expenses based on the lifestyle based on the law. And when he started getting contracts about seven years ago that was less than that. And they go to crochet, and they’re like my insider not sit, just like I can’t work for that anymore. So I had to get out and slowly just got rid of all of them and just you know, cash. And one thing he chose to do is to keep that patient, his client happy, because the bills out never he does superbills. 

And so a big part of the conversations are asking the audience kind of questions. What do you do when a potential patient calls your office and ask you that question? Do you take my insurance? Of course, what does that mean? Well, yeah, I do take your insurance. I’m on a network. Of course, we know they’ve been in the network. But they didn’t ask that. They said, he said, Yeah, I do think insurance.

Now the way you really should answer is getting the acknowledgment and permission. That’s that classic, acknowledge what they’re saying, get permission, ask questions. So DJ mentioned, I do take it, what can we talk about insurance at the end of the call? Because I got a few questions I need to ask first. And I’m going to get to your question, but more than sort of the follow-up question is, so this one, they’ve permitted you to say yes, you can answer some questions. And that question is,

what have you done? And the next one is what can’t you do? So you want to set it up? Like, what have you done? Have you tried? Has there been passed? Have you just done insects? Have you tried? I’ve been through certain nothing we’re eating? Okay, then what can you do? I can’t sit for more than 30 minutes I’m I work without comfortable.  It hurts to commute to work in the car. I’m thinking we’re having to buy a new car because I noticed my spouse’s SUV is more comfortable. I drive a sedan that propagates? know, when you get into that, you know, as those who questions you get back to the question, insurance questions,

hey, yeah, I’m gonna do some on my team is going to check your insurance benefits 48 hours before your visit, and they’ll get back to you with what they cover. And when you call them back. So a that says the most or you’re not going to get in the same day. But you can’t answer a good question of what is it going to cost them so they care about at first without checking the insurance if you’re going to do super billion out of network for them. So once you find out how you can have that conversation with them.

Because you might be shocked there, I don’t network and they’re in there because it’s part of saying corporate and these are the end of the year, they were the deductible to meet regardless, so doesn’t matter where they go. And of course,

you start that conversation with reiterating. This is what you try, this is what didn’t work. And here’s your finisher. And here are your benefits are the last time that podcast is they’re talking about like back billing and balance building your network.

If you charge 150, and they only pay 75, you can come back to the last 75. And one thing that they had to clarify for themselves over time was just because you build 150 doesn’t mean that’s a lot. So when you build 150 out of the network, you’re submitting that deals to the patient to the insurance company, to the insurance company, if they can you have to pay the patient, you want to go ahead head of the time. Okay, so if you Bill $150, that doesn’t mean insurance will reimburse a hundred $50. No one charging my bill 50 verse 30. So as always kind of gets a little confusing what’s allowable versus with Bill. So in our network, you’re building 150, maybe the only the allowable massively could ever do Is At Well, that’s what you had to collect up front.

We all know when a patient owes you money, and they feel better a month down the road, it’s really tough to get them to pay you that $45, you check the benefits correctly, you ask the right questions, after a little bit a while you should figure out you have this insurance company. And the patient probably is going to get 55 out of $150 charge reverse, let’s just say. So you know, they’re probably going to get just reverse it. If you only, let’s just say 5050. You don’t have to charge 100 over the counter. Because of that other 50, you’re going to get from the insurance company. Now, of course, it gets a little confusing.

Every plan, that plan might say, the check goes to the patient on I still need to click that 150 and they’ll just get reversed. So you really, you’re going to do this, you got to have somebody who knows what they’re doing asking the right questions, you might have to ask the same person several different ways to get the answers that you’re looking for in the network versus out of network coverage. And the last thing you want to do is you don’t like the full amount and then I’ll say go chasing for money. And even sometimes you get paid more is now and then you’ll get someone they get paid more than what you’re charging. And you have to let that paperwork know that hey, patient, you get a check for more than the 150 we’re close to this person, that extra money to us. It’s not like you’re getting paid back. Okay, you can’t make money off insurance is not, it’s not that confusing when you get to that just a lot of scenarios that you have to get answers to if you’re trying to do this crypto stuff. Now there’s some practice out there, they’re not doing any of that, that I get it, this is what I got is your sugar bill. Figure it out on your own.

Just this guy Jerry, he did it the other way around. Because he felt like it’s the patients it’s confusing. They don’t deal with it, you know, they just give their insurance card like I have no idea what’s on it, what the rules are. And so you can just check it so that they’re aware of what they’re going to cover. It’s not gonna be kind of covered just so they have financial considerations. That’s what you want probably as a patient to it can be done.

 And thank you for setting up his own like consulting firm at some point or like call center where a certain number for your clinic as far as the history, answer all the questions, get them signed up. That could be worth something. Check out that episode of cash PT  that way you get your information, and perhaps he’s got this plan ready to go to where you can avoid the confusion. Just pay somebody to do it.

That’s worth it already and write a review for us contact on social media.net on the upper right side is all the icons that you need. Already know Dr. Justin Trosclair going #behindthecurtain

Transcribed by https://otter.ai

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About the Author
Dr. Justin Trosclair, D.C., an expert in Chiropractic Care, has been focusing on back and neck pain relief for over 12 years and has delivered treatment to more than 6000 patients. With advanced training in treating disc derangement conditions, you can count on him to keep up to date with the latest research in physical medicine for spinal pain. He has 5 years of hospital experience in China, is currently working in Germany, and had a private practice in Colorado for 6 years. Dr. Trosclair hosts a doctor to doctor interview podcast called ‘A Doctor’s Perspective‘ with over 220 episodes. During his free time he wrote 3 books. Today’s Choices Tomorrow’s Health (rebooting health in 4 categories), a Do-It- Yourself acupressure book for 40 common conditions called Needle-less Acupuncture, and a step by step guide to look like a local for Chinese dinner culture called Chinese Business Dinner Culture. If you have kids, you may be interested in his 6 series tri-lingual animal coloring book series (english, spanish and chinese).