[SUEG]

Everyone loves ice cream...DME is a business just for the sick and dieing...Sorry not to be Positive but right now the reality of this business is to iffy and a lot of work for nothing. I have had the same issues for contracts in our area. We are in a pop. Of 15thousand but are considered rural AND we have an APRIA on every corner. Hang in there, fight the battle, we little guys have got to prevail somewhere.

[JoeyGraham]

Greg,

You've stumbled upon the $6 million dollar question in our industry - how to
obtain and keep private payer contracts. As you've seen from the other
responses, it doesn't look good. Further, it's getting worse as time goes
by. See this article from the September issue of HME Business:
http://hme-business.com/articles/201...ing.aspx?sc_la
ng=en

Luckily there are a couple options out there to help you: CareCentrix and
VGM HomeLink - these are 3rd party organizations that contract directly with
private payers and who subcontract with DME companies to provide the
equipment. When you're contracted with them you become "in network" for a
number of different private insurance plans. There are other organizations
like them out there. Fair warning - the reimbursement is well below Medicare
and for many products you'll barely break even (if at all).

We are lucky enough to be contracted with the majority of private payers,
but we've been in business for 25 years and many of those contracts are from
our early years when it was much easier to secure a private insurance
contract. There are a couple payers that I'm still trying to get contracts
from and I'm hitting the same brick walls as you: "our network is closed".
The only way I've found to get around it is to have an insider at the payer
who will champion your cause - it's difficult but it can be done.

To sum it up, here are the keys to success in the private payer market from
my perspective:
* Contract with 3rd parties when you can't directly contract
* Get an insider at the payer to champion your cause
* The geographic region you service matters - the bigger the better
* The scope of services you offer matters - the more the better
* They all require: NPI, accreditation, $1M to $2M in professional
liability insurance (many require that you name them as a covered entity)

Sorry I can't be more help. We all feel your pain.

- Joey

[SUEG]

Everyone loves ice cream...DME is a business just for the sick and dieing...Sorry not to be Positive but right now the reality of this business is to iffy and a lot of work for nothing. I have had the same issues for contracts in our area. We are in a pop. Of 15thousand but are considered rural AND we have an APRIA on every corner. Hang in there, fight the battle, we little guys have got to prevail somewhere.

[JoeyGraham]

Greg,

You've stumbled upon the $6 million dollar question in our industry - how to
obtain and keep private payer contracts. As you've seen from the other
responses, it doesn't look good. Further, it's getting worse as time goes
by. See this article from the September issue of HME Business:
http://hme-business.com/articles/201...ing.aspx?sc_la
ng=en

Luckily there are a couple options out there to help you: CareCentrix and
VGM HomeLink - these are 3rd party organizations that contract directly with
private payers and who subcontract with DME companies to provide the
equipment. When you're contracted with them you become "in network" for a
number of different private insurance plans. There are other organizations
like them out there. Fair warning - the reimbursement is well below Medicare
and for many products you'll barely break even (if at all).

We are lucky enough to be contracted with the majority of private payers,
but we've been in business for 25 years and many of those contracts are from
our early years when it was much easier to secure a private insurance
contract. There are a couple payers that I'm still trying to get contracts
from and I'm hitting the same brick walls as you: "our network is closed".
The only way I've found to get around it is to have an insider at the payer
who will champion your cause - it's difficult but it can be done.

To sum it up, here are the keys to success in the private payer market from
my perspective:
* Contract with 3rd parties when you can't directly contract
* Get an insider at the payer to champion your cause
* The geographic region you service matters - the bigger the better
* The scope of services you offer matters - the more the better
* They all require: NPI, accreditation, $1M to $2M in professional
liability insurance (many require that you name them as a covered entity)

Sorry I can't be more help. We all feel your pain.

- Joey

[SUEG]

Everyone loves ice cream...DME is a business just for the sick and dieing...Sorry not to be Positive but right now the reality of this business is to iffy and a lot of work for nothing. I have had the same issues for contracts in our area. We are in a pop. Of 15thousand but are considered rural AND we have an APRIA on every corner. Hang in there, fight the battle, we little guys have got to prevail somewhere.

[JoeyGraham]

Greg,

You've stumbled upon the $6 million dollar question in our industry - how to
obtain and keep private payer contracts. As you've seen from the other
responses, it doesn't look good. Further, it's getting worse as time goes
by. See this article from the September issue of HME Business:
http://hme-business.com/articles/201...ing.aspx?sc_la
ng=en

Luckily there are a couple options out there to help you: CareCentrix and
VGM HomeLink - these are 3rd party organizations that contract directly with
private payers and who subcontract with DME companies to provide the
equipment. When you're contracted with them you become "in network" for a
number of different private insurance plans. There are other organizations
like them out there. Fair warning - the reimbursement is well below Medicare
and for many products you'll barely break even (if at all).

We are lucky enough to be contracted with the majority of private payers,
but we've been in business for 25 years and many of those contracts are from
our early years when it was much easier to secure a private insurance
contract. There are a couple payers that I'm still trying to get contracts
from and I'm hitting the same brick walls as you: "our network is closed".
The only way I've found to get around it is to have an insider at the payer
who will champion your cause - it's difficult but it can be done.

To sum it up, here are the keys to success in the private payer market from
my perspective:
* Contract with 3rd parties when you can't directly contract
* Get an insider at the payer to champion your cause
* The geographic region you service matters - the bigger the better
* The scope of services you offer matters - the more the better
* They all require: NPI, accreditation, $1M to $2M in professional
liability insurance (many require that you name them as a covered entity)

Sorry I can't be more help. We all feel your pain.

- Joey

[JoeyGraham]

Greg,

You've stumbled upon the $6 million dollar question in our industry - how to
obtain and keep private payer contracts. As you've seen from the other
responses, it doesn't look good. Further, it's getting worse as time goes
by. See this article from the September issue of HME Business:
http://hme-business.com/articles/201...ing.aspx?sc_la
ng=en

Luckily there are a couple options out there to help you: CareCentrix and
VGM HomeLink - these are 3rd party organizations that contract directly with
private payers and who subcontract with DME companies to provide the
equipment. When you're contracted with them you become "in network" for a
number of different private insurance plans. There are other organizations
like them out there. Fair warning - the reimbursement is well below Medicare
and for many products you'll barely break even (if at all).

We are lucky enough to be contracted with the majority of private payers,
but we've been in business for 25 years and many of those contracts are from
our early years when it was much easier to secure a private insurance
contract. There are a couple payers that I'm still trying to get contracts
from and I'm hitting the same brick walls as you: "our network is closed".
The only way I've found to get around it is to have an insider at the payer
who will champion your cause - it's difficult but it can be done.

To sum it up, here are the keys to success in the private payer market from
my perspective:
* Contract with 3rd parties when you can't directly contract
* Get an insider at the payer to champion your cause
* The geographic region you service matters - the bigger the better
* The scope of services you offer matters - the more the better
* They all require: NPI, accreditation, $1M to $2M in professional
liability insurance (many require that you name them as a covered entity)

Sorry I can't be more help. We all feel your pain.

- Joey

[gdseas]

Originally Posted by Regina

I don't have good news. We were already participating with Highmark BC, and they suddenly began processing claims out-of-network for one of our locations. In the midst of trying to correct that problem, they decided that both of our locations needed to re-apply. It took more than six months, due to the fact that the person assigned to us had a sudden medical emergency(about which I am still highly suspect), and they didn't bother to assign our case to anyone else. That left us sitting on claims from the one location to avoid the payments being made to the patient. It was a nightmare- months of unanswered phone calls and e-mails, and then a bad attitiude from the person when she finally returned.
We also have applied to various insurance companies, mostly because we have prospective patients coming in asking us if we accept the insurances, and have been told that "they have enough providers in our area". We also had an insurance company turn us down because we were not JCAHO certified. It was the only certification they would accept.
I wish you luck. It takes tenaciousness and patience to deal with insurance companies today! Sorry, no help, just bad anecdotes!

Thank you Regina for sharing. I begin to see the craziness first-hand. Yours sounds like a painful experience....Hope things improve.

It seems that the reasons for the insurance carriers to do anything is random. So if it was not JCAHO, it could have been having a ...three-digit telephone area code...

[gdseas]

Originally Posted by SUEG

In my humble opinion after being in this business for over 30 years, you would have been better off to buy a used car lot for sales...Good Luck

Oh please don't tell me this after the amount of work and money I have spent on this....

[Mike Kuller]

I think Joey mentioned in one of his bullet points, finding a champion inside the payer to help you. You may have to find an MD on the outside to champion you in order to get inside the payer. One who knows their Medical Director, for example.

Otherwise find a small provider in your area who has some of the contracts you want and buy them.