Office Ally Update – “Non-Participating” Insurance Companies

You may have received a notice of a possible change in fees charged by the claims clearinghouse “Office Ally.” We want to help you understand this change.

Office Ally's fee policy in itself has not changed: "There are no set-up fees, monthly fees or per-claim fees for electronic claims submission to Participating Payers. For electronic claims submissions to Non-Participating (NP) Payers, if more than 50% of your monthly claim volume is made up of claims to Non-Participating Payers (indicated by a "G/NP" in the Type column of our Payer List), then your account is assessed a fee of $19.95 for that month."

What HAS changed, then? Office Ally has experienced a decrease in the number of “Participating” insurance companies using their services. The “Participating” companies pay Office Ally a fee for pre-processing their claims: this was historically their chief source of income. But now more and more companies are refusing to pay for Office Ally’s services: these are the “Non-Participating” companies. Though this used to be limited to government programs like Medicare and Medicaid, and BC/BS in many states, their “Non-Participating” list now includes several more insurance companies.

Why has this changed? The Affordable Care Act requires insurance companies to spend at least 80% to 85% of premium dollars on medical care. As a result, insurance companies are very cognizant of the amount of money being spent on processing claims and are continually cutting and eliminating payments to clearinghouses, such as Office Ally. Another change is that, in the past, most claims were submitted on paper. The insurance companies wanted to encourage electronic claims submission, so they were willing to pay pre-processing fees as an incentive. Now, paper claims are rare, so they are less concerned with providing this incentive.

We are certainly disappointed that more insurance companies have decided to avoid paying pre-processing fees, but we have no control over this. However, we understand that Office Ally has to have SOME source of income to stay in business. So long as at least 50% of the claims they handle for you generate income, they are fine with letting this be their sole source of support. But if the majority of the claims are from "Non-Participating" companies, they charge you a fee to make up for their losses. The bottom line is that you are now less likely to have 50% or more of your claims going to a "Participating" company.

Even though Office Ally is a completely separate company, we have always published their policies on our own website (www.therapyappointment.com) in the “Rates and Discounts” section. We do this to ensure that there are no “hidden costs” associated with our services, even though these are Office Ally's fees, not ours.

It is worth noting that, even with these fees, Office Ally is still the lowest-cost clearinghouse available for the majority of our customers. Other competing clearinghouse fees range from $39.00 – $95.00 per month. This is the reason that TherapyAppointment has chosen them to work with our customers. If there were a lower cost alternative, we would chose that company, instead. If an alternative becomes available, we will make a change; if we are able to negotiate a better deal for our customers through Office Ally, we will do so.