Payor Puns

Hello all. I work with a company who primarily has TRICARE cases, my entire caseload is TRICARE. What is the payor world like outside tricare? Can you supervise full sessions instead of x2 hours? Can you do concurrent billing? How much coverage do you get for reauthorization? I'm seriously considering a company change to get away from only working with TRICARE, but im worried the grass isn't actually greener. HELP

Would greatly appreciate it. Thank you!

Forgive me if I’ve missed a discussion on this topic already, but all I can seem to find is information about child support while on ODSP as the recipient. My partner is currently on ODSP and we are trying to get clarification on whether or not it counts as income when it comes to child support or if it is exempt?

Current Role: high impact, cool strategic projects, high visibility to senior leaders

Payor relations: high growth company, not completely finance related, will work on specific type of work related insurance payors.

Ops finance: subsidiary of large health company; more mundane FP&A role.

View Poll

Hello;

I’m gonna admit, I’ve been neglectful for months about this, so the particular goal is off by a thousand dollars. I’ll reconcile and adjust once I get this figured out.

Basically, in The Before Times, I opened an account at an online bank that offered a higher interest rate and began to fund my “Fuck Out of America” in there through transfers from my credit union. At some point, the transactions were no longer categorized as the fund goal, but were categorized as transfers from the credit union to the bank. I got lazy about it and didn’t change it until the current messup with Plaid.

Problem is that I’m nit sure how to get it to say it’s no longer a transfer but it’s going to the fund. I’ve tried to change the payor but that’s not working, and I can’t change the category as that’s grayed out.

Sorry if this is a silly question, but I’d like to fix it. Thanks!

When you get your 2021 renewal papers for your car insurance (and likely home), you will be hit with a 3% “instalment fee” if you pay monthly. I spent about an hour on the phone with them yesterday and they will NOT negotiate to remove this money grab. I have been a customer for over 30 years, no claims and no tickets. So to avoid the price gouge you need to pay in full for the year. Save your money folks.

For all of you SNF SLPs—we were just told that one discipline cannot carry someone on Part A services and that it must be at least two disciplines for this payor source, otherwise they will be under Part B etc. This is new to me and to my team and I was wondering if other people have been told this? Our building is under new management and our company is relatively new to the building so we’re trying to check and see if this is legit or if we’ve got some wool being pulled over our eyes! Thanks 🤘🏼

Where to put lawsuit settlement winnings (not physical injury) on tax return if you did not receive a 1099 from payor?

Won $3000 in small claims for breach of contract (not a reimbursement). Defendant (a person) refused to pay so I got a lien and was able to get the money that way. They obviously did not give me a 1099. Where do I report this on my tax return and at what rate/percentage would it be taxed?

Hello all. I'm a volunteer in a Boy Scout troop. We provide a fundraising service where our contributors pay an annual subscription fee. Currently, I create the invoice each year for 1 year. But I'd like to give the payor the option of choosing to renew for 1, 2 or 3 years. Is there a way in PP invoicing that allows them to select that quantity? Keep in mind, this is a service, not a product. Currently, I'm putting in the notes that if they want more than 1 year, just double the payment and I'll know it is for two years. However, that doesn't quite have the paper trail I'd prefer. Thanks.

As far as I know, TriCare doesn't cover it and only covers 97156 (which must be provided by BCBAs or BCaBAs). Does anyone know about other insurances and what they cover during this pandemic? What is your company doing and providing with telehealth? Who is providing what services?

Kill me. Just... effing kill me. (Okay, not really, but anywho.)

So, I’m a nurse but I’m a clinic nurse. I deal with refill requests, angry people, and prior authorizations all day. I feel like this sub verbalizes more of my thoughts than nursing ones. Maybe y’all can help me.

I just wasted 43 minutes on hold with BCBS of TN, to find out my pt is not even covered by them for RXs but by CVS Caremark. There was no indication of this anywhere in pt’s chart or financial info. Then called Caremark and in three minutes was told there’s no PA needed for the drugs in question.

Where can I find a list of companies that use CVS Caremark as their RX carve out?

Any help is greatly appreciated!! Thanks in advance for reading.

Came across some videos online, was hoping to hear from someone who defines themselves as a classical liberal.

I read some random threads from months ago, some stating that you cant pursue life without health, and another stating that government can't have any hand in healthcare whatsoever.

So, the question is, "Can a classical liberal believe in single payor healthcare?"

really interested to hear your thoughts, thank you

I had a check stolen, well several, but only one has caused me troubles. This check was written to me for an overpayment I made for a medical bill (I paid the total out of pocket, then they billed my insurance, and issued me a check for the difference). Someone stole the check and forged my signature and then wrote theirs below. I cannot find out any information on the check or what account it was deposited into without the payor, in this case the hospital, filing a fraud affidavit with their bank.

The hospital will not reissue the check and say that they are not willing to file a fraud affidavit or similar document with their bank. They say I am shit out of luck when it comes to the money. What do I do?

I have already filed a police report.

Everyone loves complaining about people taking opioids. Everyone loves saying they want to help reduce the use of opioids. Insurance companies don't want to put their money where their mouth is, though, and actually pay for treatments that help patients avoid opioids.

I have severe migraines related to neck hypermobility. I'm allergic to nsaids and after trialing numerous triptans, they either are ineffective or have intolerable side effects.

Physical therapy that helped immensely? Max 20 sessions per year. So I used that up in less than three months.

Topical compounded pain cream? Not covered at all. Better pay out of pocket.

Cefaly TENS unit? Also not covered.

Medical marijuana? That's out of pocket too!

New biological medication that has almost completely eliminated my migraines? Prior auth denied!

120 Percocet tablets? $5 please

Thankfully I'm able to spread out my PT better this year, unlike last year when I didn't know about the limit of 20. I'm able to afford to pay for Cefaly and marijuana out of pocket. I'm on a financial assistance program with the denied medication. However, someone with fewer means than me? I can see how they would just end up using Percocet or whatever else all the time.

Hey Healthcare folks --

Our company is trying to sell our service that helps speed up healthcare delivery to patients and reduce costs. We tried D2C and its going, albeit slow, so we think selling to payers might be the better solution. Have you done this before? If so how? How difficult was it? What was the timeline?