Healthcare Legal Expert Needed - Plus if you have Payer Experience
Lawyer or paralegal who specializes in healthcare needed for advice about how to charge patients a cash fee for a virtual or telemedicine visit with their doctor without violating payer contracts that have a gray area and/or preclude doctors from charging for these types of visits
We want to give doctors the the option to extend a service to patients that would give them the ability to pay a premium fee (out of their own pocket) for a virtual consultation for convenience sake, regardless of if the patient is a PPO, HMO or Medicare patient. For example, if I want a non-urgent prescription refill I should be able to pay $40 for a phone call with my doctor to get it done and am willing to because it saves me time and energy.
Some of our ideas on this include setting up another Corporation unique to the doctor's practice that does NOT contract with payers so they can offer this service as an ancillary business or possibly having the patients sign a waiver acknowledging that they understand it will not be covered by insurance.
We are going to hire 3-4 people to provide suggestions for possible workarounds and the best option will get an extra $750 cash bonus. We are looking for highly experienced lawyers in healthcare. A plus if you have experience working with or at the major payers.
One of the main debates is whether telemedicine consultations are "covered" by the payer. If it is, the doctor can't charge the patient a cash fee. If it is not covered, they're allowed to charge a cash fee. A typical example of a non-covered procedure would be cosmetic (a nose job let's suppose), where the patient would be expected to pay for this discretionary procedure versus a telemedicine consultation which may be included and covered generally and/or depending on if the issue being discussed is related to a previous physical office visit. If contracts explicitly state that telemedicine is a "covered" service we'd also want to seek solutions as to how we'd still be able to charge a cash fee to patients to work around this.
We'd like you to keep track of all your findings in an organized manner and presented via PowerPoint or Word Document that concisely presents all the findings and research. If there are differences that vary state to state, we'd also like that written out in a spreadsheet organized by how each state handles this.
- US based and Barred Lawyer or Certified Paralegal
- Healthcare and health insurance legal knowledge
- Health insurance contracts / payer experience is a plus
Here are some helpful links on the matter: