Urgent - Insurance Alert

INSURANCE ALERT

MEDICARE COVERAGE in JEOPARDY

Access to quality physical therapy is in jeopardy! The Super Committee will be voting November 23rd on the final rule, deciding whether to make drastic Medicare cuts. If you are not affected by this, your mom, dad or grandparents may be.

The final rule announces that there will be a 27.4% cut in Medicare payments for physicians, physical therapists, and other health care professionals based on the flawed sustainable growth rate formula (SGR). Congress must take action to prevent this cut by January 1, 2012. According to Centers for Medicare and Medicaid Services (CMS), the Obama administration is "committed to fixing the problem, ensuring these payment cuts do not take effect."

Continuing to provide quality physical therapy care under insurance requires reasonable reimbursement rates. If this cut goes into effect, we may not be able to continue serving our valued Medicare patients through insurance billing.

TAKE ACTION!

GREAT NEWS ABOUT CIGNA INSURANCE

For those of you who have been using out of network Cigna benefits, as of November 1, your claims should automatically be processed as in network. Even though we try to make sure that all changes are implemented, if you see a mistake on your EOB, please let us know and we will make the necessary corrections.

Any patients who were not using their Cigna insurance, but now wish to, please give the front desk your insurance information and we will gladly start billing Cigna on your behalf.

WHY WE DON'T BILL BLUE CROSS/BLUE SHIELD INSURANCE

In many instances, using your out of network benefits for physical therapy can be cost effective. That is not the case with Blue Cross Blue Shield (BCBS) plans. Though BCBS states they are a PPO plan, in reality, they function like an HMO, because the truth is, you do not have reasonable out of network benefits.

BCBS only allows a maximum reimbursement rate of $70 per visit, regardless of the charges ALTA bills. Following is a typical scenario:

"Bob" has a BCBS plan stating it covers 70% of charges, and his portion is 30%. Let's say ALTA bills $175 for the session (this dollar amount is an example only):

BCBS pays 70% of $70 = $49

Bob owes 30% of $70 = $21

$70

What happens to the balance of $105? Bob is responsible for it, in addition to the $21, so that he would owe $126 for his visit.

Furthermore, BCBS will credit Bob only the $21 (30% of allowable) towards his out of pocket expenses.

This is why we advise patients not to use their Blue Cross insurance - it just costs you more. We know this can be confusing and frustrating and we hope our explanation helps you understand the issue better.

Blue Cross is the only insurance we know that uses this formula for processing out of network claims. Most insurances pay at a higher rate and give you full credit for all your expenses.

2955 Baseline Road

Boulder, CO 80303

303-444-8707