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In a chiropractic or acupuncture practice or small practice, I would assume this is already the case with a financial agreement. See the attached forms one for in and one for out of network.
For in-network, it’s fairly easy as it is a set copay or amount. However, out-of-network providers must make patients aware of what their total charges are and that there’s no guarantee that the patients' insurance would pay the full amount and therefore the patient could be liable for the entire billed amount.
Part of the law also emphasizes that insurance companies must be more transparent as to the amount that they would allow as well as give providers information on their allowed rates
It also requires insurance carriers to keep their list of providers up to date so that patients who choose a provider based on their list is not later liable for amounts when the provider was out of network
Carriers will have to update their list every regularly verifying those providers are in or out of network so that patients can have a clear choice of providers and not be worried that the provider may be out of network
The estimate range must be no greater is $400 which should be within a decent margin for Chiro services.
In simplest terms, an office must disclose the cost of their services and provide a good faith estimate of what the patient may or will be liable for.
- Be specific to each patient; a generic list of fees is not acceptable.
- Include the cost of expected items and services.
- Provide this information orally and in writing.
- Have the patient to sign the written estimate.
- Must be in an accessible format for the patient (ie may need to be in a different language).
- Should include estimates from any other providers who may be involved in care (ie massage, imaging and should note if any of these services and whether that provider is in or out of network).
- Include the expected scope of any recurring primary items or services (such as timeframes, frequency, and the total number of recurring items/services).
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Cannot exceed 12 months for recurring items/services."
If you have any questions or concerns, feel free to contact me at alexandereisner@shawnsteel.com.
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