We recently hired a new OD and need to put her on the panels with medical insurances.
She is TPA cert.
Where can i get an uptodate list of insurance companies that have presence in NY area?
Can someone post them?
All help apriciated!
Is it true that the compensation for the same codes exams to an OD and MD is different?
One of the easiest ways is to look in your phonr book for HMO'S
If you call the provider dept generally they will hewlp you to find the other companys.
You could also look at all of the customers that you now have, and use their Ins cards, med Med benefits, and call a few, generally speaking, most Ins companys will be happy to send you rates structures, and code list along with an application.
Make sure that you call the pharmacy dept of each of the Med Ins companys, to find out their rules for use of the TPA. They all have a differenr formulary and rules for using some of the drugs IE we just had a situation that the Ins Co, required the use of different scripts for allergy treatment. We had to try each of 2 drugs first before we had to submitt proof of use, and request for Patenol.. It is so expensive they want to get out cheap if at all possible.????
As an office manager I understand, but, with patient care, shouldnt it be do the right thing the first time??? But who am I to judge.
Hope that this will help you
Rev
I am sorry for the spelling errors, but it is late and I forgot to check it
UX UX
I spent 3 full days gathering this info about comercial, FHP and medicaid medicare plans.
It looks lke that it is much harder to talk to them and try to explain that i am not looking to do refractions for them but we are actualy trying to treat them.
Some insurances dont even have Optometry as a specialty and claim that you have to be a MD to do Medical Eye exams!
If anybody needs this info i could probably post my results.
the only thing i was looking for plans that op=erate in NY area.
If there is an interest please let me know!
Sorry you had such bad luck. The Optician Society in your area may br of help also.
As a Practice/Office Manager I have never had as much trouble as you have described and I hope I never do.
If I can ever be of help you can let me know and I will do my best
Rev
Thanks Rev!!!
Lenny:
Please let me know who the insurance companies are that insist on MD medical eye exams and treatment. If you found any of these that refuse to pay for self referral I would expecially like to know who they are. Sounds like they might be my kind of company.
Chip
What do u mean by self referal?
Lenny,
He means ODs who do an eye exam and then fill the eyeglass Rx. He has that beef against ODs. But for some reason, it's OK if MDs (ophthalmologists) do it. And of course, someday if opticians get to independently refract, it would be OK for them to do it.
Actually, if you've read the multitude of posts that Chip has made in this area, you'll know that it is definitely NOT ok for MD's to dispense either.
Many of us believe in the separation of the refraction/Rx production process and the dispensing process. And, if I ever am allowed to refract independently, I will. Why not? Your husband is allowed to dispense, which is my specialized training. In my book, if it's legal...it's legal. Morals and ethics have little to do with legality.
Chip!
Unfortunately this is the story.
The Insuranse company would put MD on the panel to provide medical exams and refused to take TPA certified OD on the panel.
They will take any OD on their affiliated panel to provide Routine eye exams. This is usualy done thru VSP, Davis and other simular organisations.
hope this helped
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