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Patients and Providers Across America Gain Control of their
Healthcare Payments and Practices |
FAQ
What
is the AAPP?
For
patients:
How
do I find participating
providers?
Do
you credential or monitor your
providers?
What
if my doctor is not on the list
or there are no providers in my
area?
How
much will SimpleCare save
me?
What
if I move or need medical care
while traveling?
What
about insurance?
What
if I need a medical specialist
or alternative care?
Can
patients also be involved as
sponsors?
How
are membership fees used?
Will
SimpleCare reimburse my doctor?
Do
pharmacies offer SimpleCare
prices?
I
still have questions. Can
you help?
For
providers:
Is
it legal?
What
is my "best price," anyway?
How
does SimpleCare help me attract
new patients?
How
does SimpleCare "code" services?
What
about the costs I incur if I let
patients enroll at my clinic?
What
about Medicare?
Other:
Why
should employers offer SimpleCare?
Why
should insurance companies offer
SimpleCare?
What
is the AAPP?
SimpleCare
is a program of the American Association
of Patients and Providers (AAPP), a
non-profit organization.
The AAPP was founded by
physicians to form a unique association
of patients and health care providers
that work together to implement
patient-focused solutions for our ailing
health care system.
By joining SimpleCare, you
are also a member of the AAPP.
To learn more about the AAPP and
the other non-profit health care
programs we offer, visit www.aapp.net
For
Patients:
How
do I find participating providers?
Our
website includes a continually updated directory
of SimpleCare providers,
searchable by location or
specialty. SimpleCare is
rapidly expanding nationwide, so be sure
to check back for additional
providers.
What
if my doctor is not on the list or there
are no providers in my area?
No
problem. We want you to have the
freedom to visit the providers you want
instead of restricting you to a
list. We encourage you to let your
health care providers know about SimpleCare,
and we will gladly present your doctor
with information about the
program.
What
if I move or need medical care while
traveling?
You
can visit SimpleCare providers
anywhere in the United Sates by showing
your membership card.
If you move, just visit a local
SimpleCare provider and/or find
new providers and ask them to
join.
What
if I need a medical specialist or
alternative care?
With
SimpleCare, there is no limit on
the type or number of licensed health
care providers you can choose or ask to
join, including both traditional medical
doctors and alternative practitioners
(physicians, hospitals, cardiologist,
oncologists, pharmacists, naturopaths,
chiropractors, licensed therapists,
etc.).
We realize your medical needs may
change, so you can change doctors or
request that other providers join
anytime.
Do
pharmacies offer SimpleCare
prices?
Pharmacies
are joining SimpleCare and
offering their ?best price.?
You can ask your local
pharmacist(s) to join just like any
other licensed health care provider.
Do
you credential or monitor your
providers?
SimpleCare
providers are licensed and governed by
their appropriate professional
organization(s).
Since other agencies review and
enforce provider credentials, it is not
necessary for us to perform these
functions.
But most importantly, patients
have the freedom to choose the quality
health care providers that are
appropriate for them.
How
much will SimpleCare save me?
Many
SimpleCare providers have reduced
their standard fees 30% to 50% for
SimpleCare patients.
Each SimpleCare provider
determines their ?best price,?
therefore savings will vary by provider.
You could save more than the
annual AAPP SimpleCare membership
fee ($29 per individual or $39 per
family) in just one trip to your SimpleCare
provider.
How
are membership fees used?
The
American Association of Patients and
Providers operates on a very limited
budget.
The $29 fee for individuals and
$39 for a family equates to less than 10
cents per day.
This minimal amount is used for
normal office and administrative
expenses, as well as provider network
expansion, printing and mailing member
materials, member/customer service, and
assisting patients, providers and others
organizations with inquiries.
Your
AAPP-SimpleCare membership fee
also helps the AAPP offer other
innovative programs for our ailing
health care system and the 44 million
uninsured in our country. For more
information about these programs visit www.aapp.net
Can
patients also be involved as sponsors?
Yes,
definitely. If you are putting in
the effort to enroll providers and other
patients, we will reimburse you for your
time. There is no obligation to be
an associate or a sponsor. Some
people just like telling others about
the AAPP and the SimpleCare
program because it makes so much
sense. Others would like to really
get involved and help get many people
enrolled. It works the same for
patients and providers. The
non-profit AAPP is all about helping
both patients and providers build
a common-sense, patient-focused and
principle-centered health care
system. At your request, we will
gladly send you more information about
becoming a sponsor.
Will
SimpleCare reimburse my doctor?
No.
SimpleCare is not an insurance
company. Participating doctors,
labs, etc. voluntarily lower their fees
for SimpleCare patients who pay
in full at the time of service.
Health care providers who do not
participate in SimpleCare will
not have the SimpleCare system
set up in their office and will not
offer SimpleCare
prices.
For
Providers:
Is
it legal?
We
have worked with our lawyer to ensure
that SimpleCare fully complies
with all laws governing healthcare and
insurance. SimpleCare is designed for those without insurance
and those with high-deductible or major
medical insurance.
We have been
assured by Medicare that patients who
are not receiving benefits from the
Medicare program do not fall under
Medicare guidelines and you are free to
charge them what you want.
It
is important to remember that SimpleCare
is NOT designed to be a "discount" program. It
is designed to be a program that allows
doctors to charge a fair and
reasonable price for their service,
and be reimbursed in full at the time of
service, without incurring the high
expense of billing and coding associated
with most insurance and third party
contracts. Medicare
patients may still benefit from SimpleCare if a service is not covered by Medicare
(cosmetic surgery, preventive services
etc.)
Patients also have the right
to specifically tell you to not bill
Medicare for confidentiality reasons,
and SimpleCare may benefit them
in this situation also. See below
for more details about Medicare. This
information does not substitute for
legal advice. If you are still
concerned about the legality of SimpleCare,
please consult your attorney.
What
is my "best price," anyway?
You
establish the SimpleCare price
that is fair for you and your patients.
By eliminating administrative costs
associated with activities such as
billing, producing insurance claim
forms, coding diagnoses and procedures,
referrals, authorizations, payment
delays, EOB reviews, claim denials,
re-submissions, collection risks, and
other "managed care? costs, you
provide patients a fair price for
services without the administrative
hassles and bureaucracy. Many
physicians reduce their standard billed
charges 30% to 50% for SimpleCare
patients and benefit financially, but
your SimpleCare price is your
decision. Additional information is
provided in your membership kit on how
to reduce your paperwork and unnecessary
administrative costs, and guidelines for
establishing a fair profitable price.
How
does SimpleCare help me attract
new patients?
Membership
to AAPP/SimpleCare includes a
listing in our searchable online
directory, including a provider web page
with pertinent information about your
practice. Patients can find
participating providers by searching the
directory or calling the membership
center.
SimpleCare
is increasingly gaining attention in the
news. Patients will identify your
practice as belonging to SimpleCare
and they will know they can receive your
"best price" when paying in
full at the time of service. To
strengthen this association, you may
wish to include SimpleCare in
your advertisements and send a press
release to the media in your area,
specifically mentioning your practice in
conjunction with SimpleCare. Contacting
other SimpleCare providers in
your area can also help to generate new
business.
The
AAPP assists SimpleCare patients
in finding participating providers in
their area, but it is important to note
that the AAPP is NOT a referral agency
and should not be relied upon as
such. SimpleCare's primary
function is to make your clinic more
cost-effective and efficient when
dealing with self-pay patients.
How
does SimpleCare "code"
services?
We
created a simple coding system--3 codes
rather than the approximately 7500 codes
found in the CPT book that are updated
every year.
SimpleCare is a totally
different service and does not involve
billing, therefore you should not use
the CPT or insurance billing coding
scheme for SimpleCare patients.
With SimpleCare, you are
not performing all the billing and
administrative services included in your
CPT/insurance bills.
To
distinguish SimpleCare from other
services, we use Short, Medium, and Long
to describe most visits and common-sense
descriptive words that you choose for
other services.
This simple approach saves you
time, avoids confusion, and reduces your
legal exposure for accidentally
miscoding a service.
Some
doctors erroneously think the CPT manual
is a required legal document and has to
be used for all patients.
The CPT code book is a joint
venture between the AMA and HCFA that
has been adopted by some insurance
companies, but is not required for other
purposes. The AMA is
currently under legal attack for their
monopoly on CPT codes. In a recent
article in AMA News, Ted Lewers, MD,
writes, "Nothing... prevents the
federal government or any private
insurer from choosing another code set
over CPT. It is possible for a new
coding system to be introduced by groups
far removed from hands-on patient
care."
I
would like to let patients enroll at my
clinic. But what about the costs I
incur by doing so?
The
AAPP is a grassroots association that
believes in the spirit of patients,
physicians and allied health care
providers working together to improve
the current health care system. We
are confident that the simplicity of the
program speaks for itself.
We
do not want our members to incur
expenses as they get others involved in
the program. We have chosen to pay
an administrative fee (from the
membership fees collected) to offset the
time and minimal expense involved in
getting people involved in this
humanitarian effort. We encourage
you to let your patients know about
SimpleCare. Copy the original
forms included in your membership packet
for distribution, and have your
receptionist collect the enrollment form
and a check/charge card information from
the patient and mail it directly to the
membership center.
The
copying, receptionists time and the
postage to send the enrollment forms to
the membership center are paid by the
doctor initially. We have designed
a sponsor program for those who decide
to help AAPP. More details
will be included in your membership
packet.
What
about Medicare?
Physicians
and health care providers are often
concerned about compliance with
Medicare.
Based on our research and
conversation with HCFA, providers may
charge SimpleCare prices for
services or patients not covered
by Medicare.
Of course, Medicare rules and
regulations do apply to Medicare
providers when providing Medicare
covered services to Medicare patients.
The following provides more
specific information:
Medicare
Providers
Services
or patients not covered by Medicare are
not subject to Medicare rules and
regulations (based on information
obtained from the Medicare office at
701-277-6782).
Can non-Medicare patients
be charged my SimpleCare price?
YES
Can
Medicare patients be charged my SimpleCare price if the service is not covered by Medicare (Ex. Annual
Physical Exam)?
YES, but the Medicare patient should
be asked to sign a private contract that ?acknowledges that the physician or
practitioner is not limited in the
amount that he or she may charge the
beneficiary for the items and services
furnished?
In a private contract, the
Medicare beneficiary agrees to give up
Medicare payment for services furnished
by the physician or practitioner and to
pay the physician or practitioner
without regard to any limits that would
otherwise apply to what the physician or
practitioner could charge.?
Can
Medicare Part A patients be charged my
SimpleCare price for Part B
physician services if they do not
purchase Medicare Part B?
YES
Non-Medicare
Providers
According
to HCFA Pub. 60B, providers who opt out
of Medicare may charge a different price
for Medicare covered services.
Can
I charge Medicare patients my SimpleCare
price for services covered by Medicare?
YES,
but the Medicare patient should be asked
to sign a private contract that ?acknowledges
that the physician or practitioner is
not limited in the amount that he or she
may charge the beneficiary for the items
and services furnished?
In a private contract, the
Medicare beneficiary agrees to give up
Medicare payment for services furnished
by the physician or practitioner and to
pay the physician or practitioner
without regard to any limits that would
otherwise apply to what the physician or
practitioner could charge.?
Can
I charge Medicare patients my SimpleCare
price for services not covered by
Medicare?
YES, ?Since Medicare rules and regulations
do not apply to items or services not
covered by Medicare, a private contract
is not needed to furnish such items or
services to Medicare beneficiaries? (such as routine physical exams and
cosmetic surgery).
?Similarly, where a
beneficiary, who is enrolled in a
Medicare risk-based managed care plan,
goes out of plan to acquire a service
and the plan does not cover it, the
enrollee is liable for the full charge
for the service and the physician or
practitioner does not need to sign a
private contract to collect payment for
the non-covered service.?
The
above information is based on our
research and information provided by
HCFA, it is for educational purposes
only and is not intended to substitute
for appropriate regulatory or legal
advice.
For additional information, we
suggest you contact HCFA directly or
your legal counsel.
You may also send Medicare
questions to Don Self, a writer for
Geriatrics magazine, at donself@donself.com
For
Employers:
Why
should employers offer SimpleCare?
SimpleCare
can be added as a benefit to help
employees with out-of-pocket medical
expenses such as medical services,
alternative care, or providers not
covered by insurance.
SimpleCare can be offered
as an add-on to your traditional group
health insurance or combined with a high
deductible insurance policy.
SimpleCare
can be implemented in all your employee
locations nationwide.
For
Insurance Agents:
Why
should insurance companies offer SimpleCare?
SimpleCare
can complement your high deductible
policies by allowing your clients to
save money on their routine health
care. Patients can use SimpleCare
for small items and only submit claims
for larger items that they wish to apply
toward their deductible. This also
saves money for the insurance company by
reducing administrative costs.
I
still have questions. Can you
help?
Of
course! Contact
us and we'll be happy to answer any
other questions you may have.
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