Comments on: Insurance Question – New York State http://npbusiness.org/insurance-question-new-york-state/ Resources for NPs in Business Sun, 13 May 2012 05:45:10 +0000 hourly 1 http://wordpress.org/?v=3.3.2 By: Diane Harper http://npbusiness.org/insurance-question-new-york-state/comment-page-1/#comment-1095 Diane Harper Fri, 12 Sep 2008 02:43:47 +0000 http://npbusiness.org/2007/06/27/insurance-question-new-york-state/#comment-1095 Hi, I was one of those "pilot NP's." In 2003 there were about 10 of us on Long Island that were credentialed. This allows us to bill for fee for service and BC programs that are not managed care. I have filled out the forms about 6 times to get on the BC CHP panel, HMO and Medicare HMO's but they keep turing me down. It is very frustrating. I consider myself lucky...that I can at least bill the fee for service as this accounts for about 10% of my private practice. Diane Hi, I was one of those “pilot NP’s.” In 2003 there were about 10 of us on Long Island that were credentialed. This allows us to bill for fee for service and BC programs that are not managed care. I have filled out the forms about 6 times to get on the BC CHP panel, HMO and Medicare HMO’s but they keep turing me down. It is very frustrating.

I consider myself lucky…that I can at least bill the fee for service as this accounts for about 10% of my private practice.

Diane

]]> By: Cecelia http://npbusiness.org/insurance-question-new-york-state/comment-page-1/#comment-786 Cecelia Mon, 28 Apr 2008 03:40:33 +0000 http://npbusiness.org/2007/06/27/insurance-question-new-york-state/#comment-786 Carla, You mentioned joining the IPA. Are you saying they will accept NP's as members? Thanks, Cecelia Carla,
You mentioned joining the IPA. Are you saying they will accept NP’s as members?

Thanks,
Cecelia

]]> By: Nina R, MSN, RN, CNS, BC-FNP, APRN http://npbusiness.org/insurance-question-new-york-state/comment-page-1/#comment-77 Nina R, MSN, RN, CNS, BC-FNP, APRN Tue, 03 Jul 2007 07:55:18 +0000 http://npbusiness.org/2007/06/27/insurance-question-new-york-state/#comment-77 Hi Everyone! I too have had anything but wonderful dealings with the Blues! They are so prejudiced against NPs and that is because (at least in Louisiana - home of the "good ole boys") their credentialing board consists of doctors who say they do not believe NPs have the education or training and experience that it takes to be PCPs for patients and so they deny NPs on their credentialing board and so they then deny us to be credentialed. Now that does not apply to all NPs - there are a few who have managed to pass through the cracks because they either knew someone or had connections while we poor smucks have to battle it out the best way we know how. They will pay us out of network which is 60/40 which is still outrageous because how many people can pay premiums and on top of that 40% or the bill? Not many I can assure you. We are appealing to the insurance commissioner to meet with him (this is an election year thank goodness) and let him know that we feel what they are doing is restraint of trade. It's always a hurdle and for every inch forward we are thrown back another 6 inches. Very frustrating so I can understand your delimina over the whole ordeal. Good luck and we can NEVER give up the fight although it seems too difficulty to move on. Thanks for listening, Nina Ravey new website in addition to old one (www.shirleymedical.com) new is nravey.mydiabeteseducator.org Stop by and visit every now and then and critique me if you like. Make it constructive please - i am so tired of the bashing i get all the time I don't think I could stand it from you guys! Nina again Hi Everyone!
I too have had anything but wonderful dealings with the Blues! They are so prejudiced against NPs and that is because (at least in Louisiana – home of the “good ole boys”) their credentialing board consists of doctors who say they do not believe NPs have the education or training and experience that it takes to be PCPs for patients and so they deny NPs on their credentialing board and so they then deny us to be credentialed. Now that does not apply to all NPs – there are a few who have managed to pass through the cracks because they either knew someone or had connections while we poor smucks have to battle it out the best way we know how. They will pay us out of network which is 60/40 which is still outrageous because how many people can pay premiums and on top of that 40% or the bill? Not many I can assure you. We are appealing to the insurance commissioner to meet with him (this is an election year thank goodness) and let him know that we feel what they are doing is restraint of trade.
It’s always a hurdle and for every inch forward we are thrown back another 6 inches. Very frustrating so I can understand your delimina over the whole ordeal.
Good luck and we can NEVER give up the fight although it seems too difficulty to move on.
Thanks for listening,
Nina Ravey
new website in addition to old one (www.shirleymedical.com) new is nravey.mydiabeteseducator.org
Stop by and visit every now and then and critique me if you like. Make it constructive please – i am so tired of the bashing i get all the time I don’t think I could stand it from you guys!
Nina again

]]> By: ritha bookert http://npbusiness.org/insurance-question-new-york-state/comment-page-1/#comment-72 ritha bookert Sun, 01 Jul 2007 05:20:02 +0000 http://npbusiness.org/2007/06/27/insurance-question-new-york-state/#comment-72 Hello Ms. N.Y. and Carla: In order for me to get reimbursed for children who I see that have CHIP (Child Health Insuance Program) I have to be credentialed with Blue Cross Blue Shield of Mississippi. I did not know this and thought that CHIP children are with Medicaid. They are still on Medicaid but Medicaid outsourced the service to BCBS of Mississippi. The primary criteria was that my collaborative physicians had to be enrolled with BCBS.. I can submit my own claims under my name... I have seen 2 children on CHIP and they said there is no back billing and I will be denied a claim. THe insurance for each state is different. Find out will the insurance company accept a nurse practitioner before you see the patient. You should find this out on the phone before the patient comes in... afte some people find out they may still want to see you and pay cash... I have had a grandmother to tell me she will still bring her grandchild even if her son's insurance does not recognize me because she is tired of taking her grandbabby to the local walk in clinic and she wants a more stable clinic for her grandchild... Hope this helps.. Hello Ms. N.Y. and Carla: In order for me to get reimbursed for children who I see that have CHIP (Child Health Insuance Program) I have to be credentialed with Blue Cross Blue Shield of Mississippi. I did not know this and thought that CHIP children are with Medicaid. They are still on Medicaid but Medicaid outsourced the service to BCBS of Mississippi. The primary criteria was that my collaborative physicians had to be enrolled with BCBS.. I can submit my own claims under my name… I have seen 2 children on CHIP and they said there is no back billing and I will be denied a claim.

THe insurance for each state is different. Find out will the insurance company accept a nurse practitioner before you see the patient. You should find this out on the phone before the patient comes in… afte some people find out they may still want to see you and pay cash…

I have had a grandmother to tell me she will still bring her grandchild even if her son’s insurance does not recognize me because she is tired of taking her grandbabby to the local walk in clinic and she wants a more stable clinic for her grandchild… Hope this helps..

]]> By: Carla Anderson http://npbusiness.org/insurance-question-new-york-state/comment-page-1/#comment-59 Carla Anderson Sat, 30 Jun 2007 04:11:28 +0000 http://npbusiness.org/2007/06/27/insurance-question-new-york-state/#comment-59 Hi NY NP! I am in Oregon, and still working on credentialing, but sounds like I can get on with Regence BCBSO (the Oregon Blue Cross). Have you checked the website www.caqh.org ? I think that software program is how many of the BCBS states credential providers. It also depends on how many providers in your area are already on with BC. Maybe they are saturated? The other way is through an IPA (Indep Physician Assoc). If you cannot get in through the front door, you can sometimes join the IPA, and if BC belongs get in that way.. I agree, the credentialing is a bear! It is the worst part of all of this for me! Best wishes, Carla Hi NY NP! I am in Oregon, and still working on credentialing, but sounds like I can get on with Regence BCBSO (the Oregon Blue Cross). Have you checked the website http://www.caqh.org ? I think that software program is how many of the BCBS states credential providers. It also depends on how many providers in your area are already on with BC. Maybe they are saturated? The other way is through an IPA (Indep Physician Assoc). If you cannot get in through the front door, you can sometimes join the IPA, and if BC belongs get in that way.. I agree, the credentialing is a bear! It is the worst part of all of this for me! Best wishes, Carla

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