Out of Network Transition
Hello all. For those in outpatient private practice, I have been accepting insurance for a while and was considering transitioning to out of network, as I'd like to be able to set my own fees (and not deal with all the admin associated with insurance) and I notice that many psychiatrists (and NPs) around me are all OON. I'm feeling a bit nervous about transitioning, as I imagine I will lose most of my insurance caseload in the process. I wanted to see if anyone who has started out with... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 18, 2022 Category: Universities & Medical Training Authors: Dr. Pookie Tags: Psychiatry Source Type: forums

Insurance Credentialing/Contracting
For those who have ever moved states, did you have to start over with insurance carriers' credentialing/contracting process (90-120 days)? Is a state license in the new state required, or is there any way to begin the process with your current license if you can provide the location of the intended practice? Trying to estimate how long in advance might be necessary for this whole process. Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - November 17, 2022 Category: Universities & Medical Training Authors: ErrantWhatever Tags: Pain Medicine Source Type: forums

delaying dental, eye, other care until medical school??
This is just something small I am curious about -- hoping to hear from current students -- I have been accepted to a few schools, they all are big university health systems with dental and nursing programs as well. I currently have several different healthcare needs that are non-urgent but would be really nice to take care of before I start to have a family and start residency. AKA either now! Or during school. I have pretty decent insurance now but everything would still cost me several... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 17, 2022 Category: Universities & Medical Training Authors: ready2bDONE23 Tags: Medical Students (MD) Source Type: forums

Only one spinal level for RFA with commercial insurance?
Im in PA, and some pts have UPMC insurance. I have been getting denials for 2 level MBB and RFA by UPMC insurance and have looked into the policy and procedure manual for UPMC commercial insurance (again NOT medicaid), but insurance small business owners actually pay for. Two things obviously jump out 1. No more than 1 level can be ablated in 12 months 2. Cannot ablate at level with spondylolisthesis. HAHAHAHA this is absolutely laughable. Has anyone else ran into anything like this? What... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 17, 2022 Category: Universities & Medical Training Authors: thecentral09 Tags: Pain Medicine Source Type: forums

How does wRVU works for Inpatient consultation?
Let's assume that I did full initial interview (99255) , and wrote 4 follow-up notes (I could not find CPT) for one consultation, will this considered as 1 wRVU or 4wRVU or 0wRVU?. I have heard that medicare and many private insurance companies have eliminated the use of CPT for consultation all together... (Source: Student Doctor Network)
Source: Student Doctor Network - November 9, 2022 Category: Universities & Medical Training Authors: Batman's Underwear Tags: Psychiatry Source Type: forums

Insurance companies are shameless
Joined large private practice group out of fellowship, application submitted in June to be credentialed for company. Told 90-120 day processing. Followed up weekly, told “should be good by mid-November, all is complete in August”. Last week told “missing education verification”. This week told “application is lost, resubmit and wait 90-120 days” This happened to one of our surgeons too. CEO got on phone with insurer and lost their mind, threatened to essentially drop the entire company... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 8, 2022 Category: Universities & Medical Training Authors: GlowInTheDark Tags: Pain Medicine Source Type: forums

Tail Insurance
After 6.5 years at my current gig, I am making a switch to another group. I currently have a claims-made policy with The Doctors Company and need to purchase tail. I have a quote ($21k) from TDC but I've been told I can shop around for better prices from other insurance companies. I've only had TDC, so I was hoping members here could chime in with the names of malpractice insurance companies I can contact? Thank you! (Source: Student Doctor Network)
Source: Student Doctor Network - November 7, 2022 Category: Universities & Medical Training Authors: Folken Tags: Anesthesiology Source Type: forums

What insurance to get paneled with?
I'm currently paneled with Blue Cross, which has been cool, but I'm looking to panel with another insurance to get my numbers up even more. I'm looking to panel with one more. I've thought about medicare, but I generally don't see geriatrics. Anyone know, generally, which one to get paneled with between Cigna, United, and Aetna? I've heard bad things about United, and Cigna, but unsure about Aetna. Anyone have advice in this? Thanks for any help! (Source: Student Doctor Network)
Source: Student Doctor Network - November 6, 2022 Category: Universities & Medical Training Authors: StayOnTop Tags: Psychiatry Source Type: forums

Outpatient Job Offer, Independent Contractor?
I'm hoping for some feedback regarding a job offer I've received, current PGY4 in a large city. I would be working as an independent contractor/1099 in a physician owned outpatient private practice. The practice has 3 MDs and a few PAs. They are offering a 75/25 split. The practice only takes 1 insurance or cash pay. They estimate billing about 80% 99214 +90833 which is reimbursed at ~240 for a 30 min appointment, similar for cash pay (however most pts have insurance). Staff helps with... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 3, 2022 Category: Universities & Medical Training Authors: theusual Tags: Psychiatry Source Type: forums

Patient calls for procedures
A few times per day the nurses get calls from patients who want to come in and have a procedure repeated. If less than a year, I tell them to schedule it. If more than a year I get an OV to determine what is going on. I am told from admin that it is needed for insurance precert. What is everyone else doing? (Source: Student Doctor Network)
Source: Student Doctor Network - November 2, 2022 Category: Universities & Medical Training Authors: lobelsteve Tags: Pain Medicine Source Type: forums

Help
I have been a pharmacist for a while and recently went back to the three letter Come Satan company. Recently got moved up to PM position. I have a tech that’s out right bullying me into doing stuff I’m not comfortable with. Here is what I mean. I had an rx for C-II for a 29 y/0 who’s been on the Med for about 2 years. While processing the script Insurance rejected it for PA. I faxed it to MD as per standard procedure. The tech in question was not around at the time. Then pt called an I... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 2, 2022 Category: Universities & Medical Training Authors: Xarelto-10 Tags: Pharmacy Source Type: forums

Your own health insurance when going DPC or concierge
Besides receiving coverage through a spouse’s plan, what are you guys doing as far as a catastrophic plan since they are illegal for anyone over 30? (Source: Student Doctor Network)
Source: Student Doctor Network - November 1, 2022 Category: Universities & Medical Training Authors: mark v Tags: Family Medicine Source Type: forums

UHC United Healthcare requiring NDA before signing on as provider, anybody familiar with this!
Hi has anyone when credentialling as a provider with an insurance company been asked to sign a blanket NDA to cover "rate fees" and "contractual terms" so as to become enrolled in the provider network? This seems a violation of some law, Stark Law or pushing a physician to practice medicine in the payer's best interest or practicing medicine as business vs. clinical best interest. I would like to post the NDA for your review but some blip in the footer says I can't. HIPAA pretty much covers... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - October 29, 2022 Category: Universities & Medical Training Authors: SJellyModo Tags: Anesthesiology Source Type: forums

FDA approves 'SKOUT' - a new AI device to detect colon polyps
https://www.cancertherapyadvisor.com/home/cancer-topics/gastrointestinal-cancers/fda-clears-skout-to-detect-colorectal-polyps-in-real-time-during-colonoscopy/ Interesting article that leads to more questions: Does FDA approval mean gastroenterologists can bill more for using the device vs standard colonoscopy? If so, will insurance companies reimburse for it? And on the path end, does this mean receiving more or less colon biopsies if this becomes widely adopted? I could see... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - October 28, 2022 Category: Universities & Medical Training Authors: coroner Tags: Pathology Source Type: forums

CMG Reckoning
So lately I've heard a lot of bad news from multiple sources about how CMG's are hurting financially. I've been hearing about how the No Surprises act has really cut down on pay that CMGs used to receive due to the reconciliation process. I've heard numbers quoted around a 25% payout from the commercial insurance side. I see other threads and hear personally from colleagues about Team Health taking a beating, Envision and USACS in all this debt, APP in crazy debt deals, and Schumacher... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - October 25, 2022 Category: Universities & Medical Training Authors: Pudortu Tags: Emergency Medicine Source Type: forums