What is Patient Options?
Patient Options is a discount managed care organization not unlike other you may have heard of. Its network of Providers are legally able to offer their self-pay patients a discount. Patients join for free and receive discounted care from network providers.
Why was Patient Options formed?
Health care attorneys and other private and federal compliance specialists formed Patient Options 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.
How do patients receive a discount under Patient Options ?
Patients receive a discount based on the providers’ fee schedule registered with Patient Options . This solves a problem of an illegal dual fee schedule, because Discounts are offered by Patient Options network providers, much like many other preferred provider, HMO or third party administrator 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.
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 health insurance as construed under the Affordable Care Act, but it is a discount managed care organization designed to benefit providers and patients alike.
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 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 DMPO’s?
Well one significant way we differ from traditional 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.
Is there a charge for patients to join Patient Options like traditional DMPOs?
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 to join like other DMPO networks.
Why should Providers join Patient Options as opposed to traditional 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.
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 fees 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 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 members 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 ?
Why should a patient join Patient Options ?
Patient Enrollment is FREE, and a means for them to save money on services that may otherwise cost them more money with a non-network provider.
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.