File Out of Network Reimbursements Electronically - hmmmm

[hellosarah]

Hi all, recently ran into a few out-of-network claims being sent to us for missing ICD & CPT codes.
We've been in business for over 45 years and have never put that information on our invoices but I'm sure many customers receive a reimbursement successfully.
Anywho, while I was digging around on the Internet (still unresolved), I came across this product https://getpatch.com/, which allows you to electronically file out-of-network reimbursements for patients.

$50/month + .50 per lookup + $8.00 per claim filed

Curious on your thoughts

[PartTimer]

Sounds great, if you don't want to mess with it, and don't mind losing a fair amount of money for the lack of worry. I'd rather train on how to properly file, because that is very expensive per claim. Most of the time, you'll be using the same few codes for most claims, and the folks sending out the claims in your office will finally get used to the few special cases over time and get more efficient with them.

Insurance companies (VCPs for sure) are getting much more uptight about the claims process. It's a great way to avoid paying entirely to lazy or unorganized offices, or earn interest on all the money they have sitting in the bank or tied up in investments while you figure out how to refile.

For 100 claims a month, it's got to hang around $9 or so per claim, less and less efficient if you file fewer than that. That's probably between 6-10% of your gross on those claims going out the window. If you are all clinical, that's way too much. Even with a brisk optical business that's just too expensive if you do a decent percentage out of network. It's about 15% of our claims, and I know the doctor/owner would absolutely lay an egg if I let that much (around 1% of gross, way more % of net) go.

I'd say train on the ten or so codes you'll use everyday, or find a cheaper company.

Just my pennies, good luck with whatever you do!

[hellosarah]

great input PartTimer, thanks :)

I am literally just curious about what people think and I agree with your points. The fee structure for the service seems to be disproportionate for us as a practice to offer the service.
It would be something our shop would consider if it was a little more cost effective since we are not part of any in-network group, but something to keep an eye on :)

[swes54]

I am doing a demo this morning from Patch but according to the fees above seems not worth it. I will see what they have to say. Is there a resource for OON claim forms that I can go to? We are considering offering to fill out for our patients. Any thoughts on how to do this besides contacting each insurance? Also are there any alternative programs to Patch out there? Thanks!

[braheem24]

I am doing a demo this morning from Patch but according to the fees above seems not worth it. I will see what they have to say. Is there a resource for OON claim forms that I can go to? We are considering offering to fill out for our patients. Any thoughts on how to do this besides contacting each insurance? Also are there any alternative programs to Patch out there? Thanks!

Was the price quoted above correct?

[aaronsmith]

Was the price quoted above correct?

Actually the pricing has changed to a subscription model now (no more charges for claims or eligibility checks), so it may be worth while to check it out again and see if it works for you.