How it works in Dr. Susan Dimick’s Office
(The Chicken Letter)
Why am I out of network with Health Insurance?
If I was in network with your insurance company:
1) You pay a co-pay.
2) We file claims with your insurance company.
3) They tell me what they allow me to do.
4) I accept their allowable discounted fee.
5) They deny everything they can and we hire a company in New Mexico to fight with them for 3-4 months and resubmit claims.
6) They pay us 0% to 80% of the claim depending on the denials and the adjustments.
Since I have opted out of the network with your insurance company:
1) You pay for your visit when you leave clinic as you would any other provider (hairdresser, plumber, electrician,
manicurist, locksmith)… would you tell your colorist to “just bill me” or “I will pay half today”?
2) We give you a HIC-F 1500 form to file (send to your insurance company(s) with a billing sheet with proper
procedure and diagnostic codes).
3) If they deny claims, they send you a number to call. Claims get paid much more readily when each individual
patient calls and hounds them – rather than some company in New Mexico hired by hundreds of doctors, filing
hundreds of claims daily. They have a lot more to lose if they don’t keep you happy.
4) They pay you a percentage of the visit – the average is 70%. A secondary may pick up the rest. The percentage
they don’t pay approximates your co-pay if I was in network.
5) Keep a copy of the billing sheet for your records.
6) If you have HealthChoice, they refuse to send the check to you – They are the only company that will not pay
patients directly. We have tried. They will not reimburse you. HealthChoice is fee for service like Medicare.
If you have Medicare:
1) Medicare will not reimburse you for my services as the other insurance companies above will do. I have opted
out, as I have with all other companies.
2) We can’t file and you can’t file for Medicare.
3) If Medicare is your primary, no other 2nd insurance company will pay any part of what Medicare denies. You will
be given no forms to fill out.
4) Medicare will continue to cover charges not provided by me (lab, radiology, pathology, etc.)
5) I take chickens, garden vegetables, ironing services and home cooked meals in barter. ☺