Changes in the Uniform Medical Plan for 2011
Frequently Asked Questions
Q: Why are you terminating your "Preferred Provider" contract with Uniform Medical Plan (UMP).
Q: Will Uniform Medical cover Dr. Nix's services when she is no longer a contracted provider?
A: Yes, services will be covered at the "Out of Network" rate.
Q: What is the difference between a “Network” Provider and a “Non-Network” or “Out of Network” Provider?
A: “Network” Providers contract with the insurance carrier to provide services for the discounted rate “allowed” by the specific benefit plan, and they agree to write off any amount of their “usual and customary” fee that exceeds the allowable rate. A “Non-Network” or “Out of Network” Provider is not contracted with the insurance carrier, but most insurance plans, including Uniform Medical, will still pay a portion of the fees for services provided by “Out of Network” providers. However, “Out of Network” Providers are under no obligation to accept the “allowable” service rate.
Q: Will I pay more for “Out of Network” services?
A: For most health care services, Uniform covers a lower percentage of the allowable fee if services are provided by an “Out of Network” Provider. Coinsurance amounts for Dr. Nix's services will be higher than those of a contracted provider, but insurance will still cover a significant portion of her fees. By late January of 2011, Dr. Nix will likely be able to provide prospective and returning clients with more detailed information about the portion of her fee that UMP will cover.
Q: Do “Out of Network” services count toward my annual deductible?
A: The “allowable” fees for any covered services are generally applied to the annual deductible. This is true whether the service provider is contracted or not. However, any fees paid by the patient that exceed the “allowable” amount are not applied to the deductible.
Q: Will I need to file my own claims or do any special paperwork?
A: While “Out of Network” Providers are under no obligation to file insurance claims, Dr. Nix will continue to do electronic insurance billing for her clients as a courtesy. However, unless otherwise arranged in advance, clients will need to pay Dr. Nix's full fee at the time of service, and insurance checks will be issued directly to the client (or insurance subscriber). Dr. Nix bills almost all services the same day they are provided, and Regence Blue Shield (the new Uniform Medical administrator) normally processes claims and issues checks within 2-3 weeks of the time they are billed.
Q: What if I can't afford to pay Dr. Nix's full fee at the time of service?
A: Dr. Nix is always willing to discuss alternative payment options with individuals for whom this financial arrangement may not be initially feasible.
Q: Can I use a credit card or HSA debit card to pay Dr. Nix's fee?
A: Yes...Dr. Nix accepts Visa, MasterCard, and Discover cards (both credit and debit).
Q: Is there any chance that Dr. Nix may change her mind and continue to contract with Regence when they take over the administration of the Uniform Medical Plan?
A: Over the last year, insurance contracts have required Dr. Nix to write off an amount that would have been sufficient to pay her mortgage, property taxes, and homeowner’s insurance for the entire year. If she were to continue to contract with Regence, the amount that Dr. Nix writes off would increase by approximately 80% in 2011. Since Dr. Nix is already working at maximum capacity and financial efficiency she would have no way to make up such a significant loss of income, and as such would be unable to meet her financial obligations if she continued to accept Regence contracted rates in 2011.
