Patient Options was founded by attorneys, doctors and insurance compliance specialists to address the increasing regulatory and compliance issues facing health care providers who help the uninsured or under-insured- specifically doctors avoiding illegal dual fee schedules, inducement violations, false claims acts, and civil monetary penalties problems. It’s no secret that today, patients have to absorb more out-of-pocket expenses related to their health care. Certain state laws, federal laws and provider contracts prohibit many common practices among providers, specifically these laws and contracts prohibit offering discounted (different) prices for “cash paying” patients (dual fee schedule) or other inducements to patients seeking care. This has been called a dual fee schedule and insurance companies construe this as a type of false claims act both of which can get you into trouble and can be illegal. Patient Options is here to help. In this highly regulated health care marketplace, our mission is to help patients and doctors alike. We offer solutions for patients in need, and also help providers keep compliant and out of trouble. Patient Options gives providers an opportunity to offer contractually based discounts to patients.
But equally important, let me tell you what Patient Options is not. We are not a traditional "Discount Medical Plan Organization" (DMPO) that charges "fees" for Patients to be become "members" and become enrolled in the "plan" and be entitled to discounts. These are regulated in many states because of the history of patient members purchasing "memberships" and thinking they are purchasing health insurance. This history is unfortunate and gave some players in the industry a black eye for not being ethical in their sales tactics. Likewise, we are not an Indemnity Plan, HMO, or Insurer for Providers or Patients, either. We do not sell insurance to patients and Providers are still required to follow the laws in their respective federal and state regarding billing and documentation practices.
But, enough with the boring stuff... Let me tell you my personal story and what led up to this whole issue in the first place...
My wife and I are both Chiropractors. We met in school, got married, had kids, and starting working our butts off to be the "successful doctors" that the world thought we had become. The reality is a lot harder than you realize from when you start in school. Running a healthcare practice is crazy- managing staff, patients, finances, and the slew of regulatory issues surrounding healthcare today is tough. Nonetheless, we were moving ahead (and even chipping away at our student loans).
Life was fine and dandy, and then we got the Letter…
Blue Cross requested a bunch of patient notes from my wife’s clinic. We had great notes and financial policies.… or so we thought! After a few weeks, we got a letter from Blue Cross requesting we pay them back $500,000. This whole time we thought we were going to pass with flying colors… How wrong we were! And then there were fees with attorneys -who always insist to be paid up front! To make a long story short, this was devastating to my wife’s practice. I was so mad at everything, but I didn’t know what to do. I went on a mission to make sure this never happened to us again. I found ways to defend my practice against unfair audits and accusations. I paid a lot of money to learn these valuable secrets- so learn from my mistakes and don’t become a victim yourself! One of the most amazing secrets I learned was that using a traditional "Discount Medical Plan Organization" can save your practice a lot of grief from accusations of dual fee schedules, false claims acts, inducement violations, and other accusations of wrongdoing. Sure, I’d had friends that used traditional plans that some of you may have heard about. The problem was that Patients pay more to pay less- This makes no sense! Patients don’t like this idea either! All my patients want to do is get a discount in their care if they are paying out of pocket.
This made me feel like a “used car salesman”… trying to tack on some additional “membership fee” just so they can get a "discount" at my office. This felt like “the old bait and switch,” - patients don't like this, and I don’t blame them. After many years of legal fees, hoop jumping, due diligence, paper filing and hard work, we ultimately went on to found a Discount Managed Care Organization that is no charge for patients. You get all the benefits of a traditional "Discount Medical Plan Organization" without the added stress of having to upsell patients that truly need it. The cost to the doctor’s office is only $99 per month, and there are unlimited numbers of patients that can enroll in the program- all for no charge! We work hard enough getting patients through the door to create some additional barrier to them getting care they need- make it EASY for them to say YES! It’s really that simple with the same level of compliance and safety as other plans.
Here's something that's really important. You see, insurance companies are pretty smart. Not only do they recoup money from audits, but they discourage us from truly practicing in the best interest of our patients. Many of us feel like we are walking on egg shells all the time just to be safe. Looking over your shoulder every day does not make you sleep well every night….Sound familiar?
Here's something else you need to consider... An amazing defense against unfair audits is an ERISA assignment of benefits. Face it, insurance companies are out to protect themselves. Using a properly written assignment of benefits can be used as a sword to defend yourself from unruly insurance audits. Remember it can happen to you and it happens to many of us every single day. A lot of clinics are using the same letter and declaring it a home run in response to audits. But here’s the kicker…. Not just any assignment of benefits will work. It has to be written with an eye for legal detail. Don’t just think your old paperwork will work- it won’t! It has to be written in the letter of the law and use of proper ERISA designations. This is huge! Practice is hard enough as it is. We will provide this to you, when you sign up.
Our goal is quite simple. We want to make practice easier. There's an old saying K.I.S.S.- keep it simple stupid. The more simple it is the more likely you are to use it. Why complicate practice more than you need to? Remember....Don’t make the same mistakes I did- it can cost you BIG!
Until now, those patients have had to pay a "fee" for "membership" into the Discount Medical Plan. What makes us different is that we have FREE enrollment for patients, with no limits on the number of patients per provider. Simply put, patients can participate and have access to affordable health care all at no charge to them. Put yourself in your patient’s shoes- What makes more sense to them- “pay more to pay less” or would they rather “just pay less”
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