Learn to better identify limited benefit plans

Providers treating patients enrolled in limited benefit plans need to be able to identify these products and plan to ensure that they do not get caught between abandoning a patient and treating him or her without compensation. The following is a tip to make these arrangements work for both you and your patients.

Check your payer agreements. Look at the terms of your existing payer agreements to see whether they permit individuals enrolled in these types of plans to be included. Ask yourself the following questions: 

Do your payer agreements limit the products that you will accept? How is the limit defined?

What notice is a payer required to give you before launching a new product? Ideally, your contract will require a payer to give you details about the product as well as 45 or more days advance notice or a new product design to evaluate it.

How do your payer agreements define new products? Does the definition clearly include limited benefit design products?

If you are notified of a new product, what rights do you have to review the product and negotiate additional terms related to it? 

Can you opt out of new products?

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.