What is Patient Options?
Patient Options is a discount managed care organization (DMCO) unlike any other programs that you may be familiar with. Why? Patient Participation is free! Our network of Providers are able to offer their self-pay patients a discount in a compliant, contractual discount. We are not a traditional "Discount Medical Plan Organization" (DMPO) that charges fees for Patients to be become "members" in order to be entitled to discounts. Likewise, we are not an Indemnity Plan, HMO, or Insurer for Providers or Patients. Those types of entities are highly regulated, for good reason (protection of the public) and must be registered within each state in which they do business.
Has Patient Options ever been challenged?
Patient Options has been challenged a few times by different insurance companies, asserting that a provider might be using a "dual fee schedule." In each instance we succeeded 100% in defending the provider, and assuaging the insurance company's concerns, and making sure that our providers were paid what they were due. With insurance companies becoming increasingly difficult to work with, we are always willing to assist our enrolled providers to defend against any accusation of using a dual fee schedule.
Who Benefits From Patient Options?
Patients and Providers! Our mission is bipartite: 1) Provide Patients accessible healthcare at a lower cost with no "catches", and; 2) Allow providers a compliant means to work with self-pay patients in conjunction with other payor types in the same office.
Has Patient Options ever been investigated by a state insurance commissioner?
Yes. We've been vetted by several states' insurance commissioners and Patient Options has always been found to be in full compliance with all state laws. Some states, in particular, have very strict laws that apply to operating an insurance company/entity/DMPO, and Patient Options' compliance with all state and federal laws, and approval by Commissioners, makes our participants feel secure knowing that they made a sound choice.
Is Patient Options registered with my state insurance commissioner?
The role of insurance commissioners of each state is to protect the residents of that state from fraud, financial ill dealings, illegitimate companies, and others who would take financial advantage of the public. Because Patient Options does not charge patients a membership fee, or any other fees associated with their participation, there is not potential financial harm to the public. Instead, Patient Options is welcomed because it is helping make healthcare more affordable and accessible to those who are either uninsured or under-insured.
Why was Patient Options Formed?
Health care attorneys and other private and federal compliance specialists formed Patient Options in order to fulfill a need in the health care delivery system given today’s complex legal compliance environment. The Federal government and private insurance companies have stepped up auditing, regulation and enforcement actions targeting providers of all types while patients’ out-of-pocket expenses have increased. Patient Options was formed for the benefit of all parties involved.
When was Patient Options Formed?
Patient Options was formed in 2016 and has been growing steadily as providers and patients have discovered the simplicity and savings that it brings. It is designed to bring value to Providers and patients alike.
How do patients receive a discount under Patient Options ?
Patients receive a discount based on the providers’ fee schedule which is registered with Patient Options. This solves the problem of accusations of using dual fee schedules, because discounts are offered by Patient Options network providers much like many other preferred provider organization fee discounts. Unlike a traditional discount medical plan organization, there is no fee for the patient to join. Why should patients have to “pay more to pay less?" Patient Options lessens the financial burden on patients, assists providers with acquiring new patients, and provides a safe harbor for legal compliance.
What is a "DMCO?"
Discount Managed Care Organization.
How big is Patient Options?
Presently (mid 2023) we have over 750,000 patient participants and over 1,750 providers enrolled Nationally.
Do patients have to show participation status prior to getting care?
No. The doctor who is a contracted provider with Patient Options would have a signed patient participation agreement in the patient’s file as well as a copy on file in the Patient Options' database. As long as the patient is enrolled and the doctor is a network provider, they are good to go!
Is Patient Options health insurance?
Patient Options is not a health insurance, HMO or indemnity plan construed under the Affordable Care Act, but it is a discount managed care organization (DMCO) designed to benefit providers and patients alike. We do not sell to patients and patient participation is free of charge.
Is Patient Options registered with my state as an insurance entity?
Patient Options is not insurance. Because we do not sell to patients, and patients' participation is free of charge, we avoid certain scrutiny of state insurance commissioners whose goal is, in part, to protect consumers.
Can Patient Options be used by a provider in my state?
Yes, absolutely. See above for a more thorough explanation.
Can Patient Options be used in conjunction with health insurance?
No. While patients can be a participant of Patient Options and a health insurance plan, they should not be used together for the same service (CPT code) provided.
How much does it cost patients to join Patient Options?
Zero! We do not "sell" anything to the patients nor do we want our Providers to, as we believe it takes away from the Doctor-Patient relationship. We think it is important that providers nurture relationships with patients, not create unnecessary and costly hoops to jump through in order to receive care. In simple terms, providers and patients alike hate having patients “pay more to pay less” as in typical discount medical plans.
Will the patients’ privacy be protected?
Yes. Patient privacy is very important to us, as it should be, and we abide by all privacy laws and regulations.
How does Patient Options differ from traditional Discount Medical Plans?
Well one significant way we differ from traditional Discount Medical Plan Organizations (DMPOs) is that they charge patients a "fee" for enrollment. Sometimes the provider is responsible for selling the plan, and other times a sales representative of the DMPO sells the membership directly to the public. We don’t “sell” anything, because we do not charge a fee - we are free for all patients to enroll and always will be! We are dedicated to making health care more affordable for those who truly need it.
Is there a charge for patients to join Patient Options like traditional Discount Medical Plans?
No. That is what makes us unique - we don’t charge patients a fee to enroll. We feel it is a bit ironic that patients have to “pay more to pay less” by paying an enrollment fee like other Discount Medical Plan Organization (DMPO) networks.
Why should Providers join Patient Options as opposed to traditional Discount Medical Plan Organizations (DMPOs)?
The facts stack up: Do you want to act as the unpaid salesman for a profit making DMPO, and be required to sell your patients a DMPO membership that they have to pay for? No. We encourage all providers to do their research and then decide what works best for them. Check out the other traditional DMPOs, read what they have to offer and you will realize why we make sense. However, you are welcome choose to be a provider for whomever you want without any conflict . . . from us or them.
Do Providers have to have malpractice insurance to be a contracted provider?
Most, if not all, carry malpractice insurance, but are not required by Patient Options to do so.
As a Provider, can I change my fee schedule?
Absolutely, but you must make that change across the board for all patients for the same services provided. Simply send in your new fee schedule form, and create a new start date.
Can we use Patient Options for bundled, reduced price packages? If so how do we do that?
When establishing your fee schedule with Patient Options, we encourage you to create a certain fee for a given CPT code (ie. 99203= $Z, 98940=$A, 98942= $X, etc.) as a line item. However, in addition to that, some clinics adopt a "capitated fee." A "capitated fee" is a "maximum, not to be exceeded" fee that will be charged to the patient for a given service date, regardless of the number of services provided, as long as it fits a given service criteria. For example, a "regular patient visit" will have a "capitated fee" of $X dollars. A new patient visit will have a "capitated fee" of $Y dollars, and so forth. However, you must specify what is included in a "capitated fee" in your fee schedule. This also greatly simplifies the financial conversations you have with patients
Is there a limit to how much (or little) I can charge for patients signed up under Patient Options?
We encourage you to be “reasonable” in your discounts but that amount is ultimately up to you.
Can I use my Patient Options fee schedule to pay for coinsurances or copays or deductibles?
No. Your fee schedule as a Patient Options network provider should only be used for “self-pay” patients and not for any specific service (CPT code) billed to Insurance, Medicare or Medicaid.
Can I offer the Patient Options discounted fee to Medicare patients for maintenance care since Medicare won’t pay for maintenance care?
Yes. You may discount for services/procedures not covered by Medicare. We encourage you to adopt the Medicare fee schedule for services that would otherwise be paid for by Medicare but may be construed as maintenance or not medically necessary. As a side note, make sure to have the correct ABN (advanced beneficiary notice of non-coverage) form in the patient’s file
How often do my patients have to reenroll as participants in Patient Options ?
Patient Enrollment is good for 12 month from the date they sign the form and are entered in the Patient Options online database. They can re-enroll, for free, for successive 12 month period(s) after expiration.
If patients have Medicare, can they still join Patient Options ?
OK, As a healthcare provider, what's in it for me and why should I join Patient Options?
- Patient Options is a well established company with a positive track record.
- Over 750,000 participating Patients and over 1,750 Participating Providers Nationally.
- 100% track record defending clients against dual fee schedules using Patient Options correctly.
- Successfully vetted by state insurance commissioners
- Provides VALUE for patients and Doctors alike.
- Increase your patient closing ratios where a discount is truly a discount.
- Lessen practice compliance issues with fee schedules.
- No more selling patients and asking them to “pay more to pay less.”
- cost for provider is only $99/month per tax ID/clinic location.
Why should a patient join Patient Options ?
Patient Enrollment is FREE, and it provides a means for them to save money on services that may otherwise cost them more with a non-network provider. In these challenging times the cost of health care keeps increasing. We aim to keep healthcare more affordable. Provider or Clinic cost is only $99/month per tax ID/clinic location.
Who can use Patient Options?
General Practitioners - Chiropractors - Medical doctors - Dentists - Physical Therapists - Massage Therapists - Podiatrists - Osteopaths - Naturopaths - Surgeons - Urologist - Rheumatologists - Radiologists - Psychiatrists - Podiatrists - Plastic Surgeons - Physiologists - Pediatricians - ENT Specialists - Orthopedic Surgeons - Oncologists - Obstetricians - Neurosurgeons - Neurologists - Neonatologists - Microbiologists - Internal Medicine Specialists - Gynecologists - Endocrinologists -Dermatologists - Cardiologists - Anesthesiologists - Allergists - Audiologists
Patient Options creates and stores information consistent with HIPAA, DSS, and PCI standards and procedures for all patients and clinic applications. Clinic/Patient correspondence outside of website-based information may contain confidential or legally privileged information or private and sensitive healthcare information that is intended to be shared only with the named recipient. Any enclosed healthcare information may be protected under the Privacy Act, 5 USC 552 (a), and/or Health Insurance Portability and Accountability Act (HIPAA) (PL104-191) and its various implementing regulations. If this correspondence contains healthcare information, it is being provided to you after appropriate authorization from the patient or under circumstances that do not require patient authorization. Recipients are obligated to maintain it in a safe, secure, and confidential manner and this information must be protected in accordance with those provisions. Redisclosure without additional consent or as permitted by law is prohibited.