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Insurance billing


I recently moved my practice away from taking any form of insurance. In my previous location I had an insurance biller but even with that assistance, still grew tired of the games from insurance companies and spending an undue amount of time trying to get paid money I was owed. Many of my teachers when I was in school seemed to follow this same path, taking insurance and then stop taking it after they found out how much they were losing overall. Has anybody found a way that works for them were they bill insurance and find it worthwhile? Even not accepting insurance I have patients who request superbills so they can submit themselves and the insurance companies still seem to find away into my life by denying their claims which sends them back to me again and again for more paperwork. I understand that this question probably will vary significantly depending on location. In Colorado, the average payout was around $42 a treatment, fairly low for the hassles involved.


I have never taken insurnace, at the advice of my collegues and teachers. Most of them said, "If you can build a practice without it, don&#39t ever take it." Patients pay me up front and then I actually submit superbills for my patients using a free program called Office Ally. But, I ask the patient to check first that they have covereage for out of network care. If they do, I take a copy of thier card, submit a bill (it takes about 5 minutes and I do it while they are getting treated). They get back 1/3-1/2 of their treatment cost. I dont do any re-submitting (unless I made an obvious mistake) or submit charts or send explanations. when companies refuse to pay. If the cient wants to they can follow up and try to figure it out. You can take a one day class in out of network billing from AAC (I highly recommend it!) and do a free 30 minute training with Office Ally, which is a clearing house for all insurance companies. I learned at the AAC class that some insurance companies actually pay MORE for out of pocket reimbursement then they would for in network payment. I have no affiliations with either company, that is just what I found helpful.

Hope this helps.



Thanks Jasmine,

I&#39ve heard of Office Ally I&#39ll have to check it out. Using OA and having a policy of not sending follow-up information seems like a good balance between being accommodating and not taking more than a fair share of my time. I’ve also seen insurance pay more for out-of-network, the limitation being that even less people have coverage. Its still tuff when people think they’ll be reimbursed and the insurance company starts giving them the run around, I like people to enjoy coming in to the office and not having to worry about the frustration of insurance claims. Another thing I’ve done when someone asks about insurance coverage is to tell them I’ll charge a cash price a little more than their co-payment or co-insurance and save both of us from having to bill the company. If a person is willing to pay $40-$50, they are still getting a treatment for only $15 more than a typical co-pay and I will get more than the company likely would have paid to begin with, with less work on my end.


Yes, I found that clients really appreciate that I do it for them. Many of them would take the superbills but then not send them in or not know what to do with them. My thinking was that if I do it for them and they get some money back they will be more likely to return.

You are right, it is definitely a bummer to the client when they don&#39t get anything back, especially when they thought they would. That is why always encourage them to check first to make sure they have coverage for out of network acupuncure care so its not a waste of time to bill. I even tell them exactly what questions to ask when they call their insurance. And if they don&#39t have any coverage or insurance I let them use a generous sliding scale. I know that I lose some potential clients because I don&#39t take insurance, but I would rather avoid the headache of insurance even if I have a few less clients per month. Also, taking Health Savings Accounts cards and credit cards helps too. (I use the Square for this).

Good luck, let us know how it goes.



I don&#39t take insurance, though I will give the patient a bill if they want to submit it themselves. Here, the insurance companies pay $30 maximum per claim, and you have to be listed as one of their "acceptible providers." In order to be "acceptible" you have to charge $65 per treatment. My compromise is to charge $50, with up to 20% ($10) off for referrals, employee discounts for some organizations, and patients on fixed incomes. Oddly, part of the insurance requirements is that I would have to stop my discount program. At the time I inquired, the largest insurance plans here were not accepting new providers anyway.


I totally agree, that getting involved with insurance in any manner requires a lot of time and paperwork. There is not avoiding this fact. However, I have found that I can find a balance where I can make insurance work for both myself and the patients. Here's the idea:
-I have the patient "take responsibility" for their plan. They are required to check out plan coverage details and ask the basic questions about copay and deductible.
-I promise to bill their office visits while making it clear that they are responsible to cover the cost of my office rate if insurance does not make payments.
-I use an insurance billing agent to handle as much of the paperwork as possible.

Yes, it is still a lot of work, but in this way the patients will be able to afford their recommended treatments - otherwise they would give up after the first visit.


I use Office Ally. It&#39s quick and easy. ... I call the insurance company, which from everyone&#39s advice, I will probably have the patient take care of finding out whether they are covered now. (So, thanks for starting the forum ;) ... I have my patients pay for treatments until I know the insurance will be paying. When I get confirmation of a check on its way or in my hand, I begin a co payment charge. I did have the trouble of insurance not paying for some treatments once after they had been and had to give the patient a discounted price because I felt bad. It can be tricky but when you can reimburse them they are so appreciative! I suppose the more percentage of patients you have paying with insurance the more you have to cover yourself in advance. ... best of luck :)

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