Small Doctor's office wants to recommend insurance policy to patients

Arnkpc

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Denver, CO
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So, like the title says, the issue I am facing is that the doctor who own this office wants to get Patients to switch insurance. My assumption is that we are legally not allowed to do something like that. Ethically it seems clearly wrong. Apparently the Doctor is trying to avoid having to switch to EHR, so he wants to limit the amount of patients who have a certain plan because of the guidelines that the Payor sets forth (If you have 100 or more patients with this particular policy you have to switch to EHR).

Instead of switching to EHR, or not being a participating provider, he wants the patients to get a different policy, because according to the Dr A.) the policy is better for the patients. B.) it is better for us too. He believes that Offices show preferential treatment to different insurance companies and plans all the time. And he just doesn't see the problem with recommend a few specific plans. He says that he wouldn't force anybody to switch, nor would he tell them that they cant be seen if they don't. He would just tell them the pro and cons of the different policies.

Anyways, like I said, to me it doesn't sound right. I have advised strongly against doing that. We are a small office. So there isn't any compliance department, or other's who I can consult with. What I need is help finding concrete laws and regulations, that I can print out, and show the Doctor that there isn't a gray area with this. That it is straightforward. And we cannot do that. WIth open enrollment happening, I want to get out in front of this before it happens, and we start breaking some rule.

If anyone has any advice I would really appreciate it. Thanks
 
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I am having a similar issue. When we have new patient appointments we discover that they are capitated with another group. Our provider wants to tell the patient to change their capitation to our practice. I have searched and searched and cannot find a statute or law that specifically states that a provider can or cannot advise a patient on what insurance company to go with. It seems that it would fall under the Stark Law, however, I cannot find anything that specifically deals with insurance companies. Any help would be appreciated. Thank you in advance.
 

Jennikate

Networker
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Webster, Florida
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Arn that does seem off . Gilda you have a different issue and if the patient wants be seen at your office and is assigned to another provider you should be having them call insurance and get reference number confirming provider switch before seeing dr. Otherwise chances are good you wont get paid.
 
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Arn that does seem off . Gilda you have a different issue and if the patient wants be seen at your office and is assigned to another provider you should be having them call insurance and get reference number confirming provider switch before seeing dr. Otherwise chances are good you wont get paid.
Thank you for your response to my question. I am just concerned that my Dr. advising the patient on his insurance decision would be illegal. Does anyone know if there is a law against my provider advising patients on their insurance choices?
 

thomas7331

True Blue
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Laws do vary greatly from one location to another, and how the laws apply to this situation really requires an expertise in understanding the details of exactly what your provider is proposing to do here. So I would highly recommend that this question be directed to a qualified legal professional or compliance expert in your area who can ask the right questions and make sure you get valid guidance. An online forum is not the place to be getting legal advice on which to base decisions such as this.
 
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