What you don't know about billing insurance.
Updated: Jan 7, 2020
When you're looking at starting an ultrasound business, many think they'll start by billing insurance. Before you do, here are a few things to think about...
I hear it all the time - "I'm going to start my mobile ultrasound business and I plan to bill insurance." My next question is always "did you realize that you can't bill insurance as a network provider until they credential you?" Insert the sound of crickets. Chirp, chirp. This stuff is CONFUSING! These are statements I get so excited to hear because I know we can help people navigate the setup of their business to create a scenario that makes the most business sense for them.
“Insert the sound of crickets. Chirp, chirp.”
Medical insurance is likely one of the most confusing things I've ever studied. What I love about this business is that we really are helping to create a more cost effective way for patients to access care.
A Few Notes About Insurance
A couple things I find so interesting that a lot of people don't realize (even a lot of the physicians that we work with through our own mobile ultrasound business!) is that our setup saves patients money - EVEN the ones with insurance.
Consider this - a patient has insurance and has an 80/20 plan (meaning once they reach their deductible, insurance pays 80% of covered expenses and the patient covers 20%). An ultrasound at the hospital is, let's say $1,000. The same ultrasound at their physician office is $350. I have seen this with my own eyes and likely many of you ultrasound techs have seen this too as the "charges" that are being set for ultrasound. If a patient pays 20% of $2000, their out of pocket is $200. When the patient pays 20% of $350, their out of pocket is $70. If you were a patient, would you rather pay $200 or $70 for the exact same thing? I have seen these types of numbers over and over again, and the fact that as mobile ultrasound providers, we can help patients gain access to affordable healthcare, while adding additional revenue to our physician client's practice is the exact way we like to do business - win/win for everyone.
Now that we chatted about how insurance works for the patient, let's get back to the best way to initial set up your business.
When you set it up with the scenario, you must purchase your ultrasound equipment and pay to have a Medical Director (to name just a few of the major expenses) while you WAIT for insurance companies to work through your paperwork to decide whether or NOT to accept you into their network. Yes, they can deny your application and tell you that they don't need any further providers in your area. So, you're paying for equipment and a physician and can't bill insurance sometimes for months on end (I've seen some take almost a year to finalize).
The BEST way to get around this is to set your business up with a service fee model. In this scenario, your physician clients bill insurance as they're already in network, and you charge a service fee for providing the ultrasounds in their office. If you want to bill insurance, you can work on the paperwork necessary for this while you're bringing in revenue to your business instead of having that equipment sit and wait on someone else's timeline.
If you need to know more about this - let's chat! Shoot me an email and let's discuss some details to get you comfortable with how this works.