Sourcing a patient’s reimbursement rate or max allowed amount without calling ins?
I am wondering if anyone knows of a way to get a patient’s specific reimbursement rate or max allowed amount from their insurance without calling the plan. With the coinsurance and reimbursement rate we can estimate a post-deductible reimbursement amount (we are OON so don’t operate on a copay but file claims for our patients) and get them a quote for the services up front.
To get the reimbursement rate (Blue plans I know just won’t share that info at all) from any carrier like Aetna, Cigna, etc I just call the behavioral health or provider services line on the back of the insurance card. The rep will be able to tell me that my CPT code is covered at a “50% copay with a 140% of medicare reimbursement rate after the OON deductible of $2,000 is met” for example, which is exactly what I need.
Does anyone have a website, platform, service, anything they use to get the reimbursement rate besides calling? Payer portals will give the coinsurance rate but not the reimbursement rate. Availity won’t offer it. I did a demo for TevixMD and it doesn’t look like they can provide that either. Any time saved from calling would be awesome, and totally open to paid platforms as well should one exist.
Thanks in advance either way!