IHPC 2706 Survey Question Title * 1. What is your name? (optional) Name: Question Title * 2. In what state or U.S. territory do you live? Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Question Title * 3. What is your professional discipline? ND LAc DC LMT LM MD DO OD PhD RN PA APRN Homeopath Physical Therapist Occupational Therapist Other (please specify) Question Title * 4. What is the average number of patients/clients you see on a monthly basis? 0-50 51-100 101-200 200+ Question Title * 5. Is your practice cash only? No Yes Question Title * 6. If yes, do you provide a superbill (an itemized bill reflecting services rendered and appropriate billing codes) for your patients so it can be submitted for health insurance reimbursement? Yes No Question Title * 7. If you provide patients/clients with a superbill or submit claims for them, how often are your patients successful in obtaining reimbursement for your services from their health insurance provider? 0-25% 26-50% 51-75% 76-100% Don't know Question Title * 8. If your services were reimbursed by a health insurance plan, would you pursue credentialing to become part of a health insurance payer network? Yes No Maybe Question Title * 9. Are you credentialed as a PPO in-network provider and/or a HMO provider? No PPO only HMO only Both PPO and HMO What companies are you contracted with? (please specify) Question Title * 10. Have you been denied credentialing from a health insurance plan before, or after January 1, 2014? No Yes, before Jan. 1, 2014 Yes, after Jan. 1, 2014 What companies have denied you credentialing before Jan. 1., 2014? What companies have denied you credentialing after Jan. 1, 2014? (please specify) Question Title * 11. Have your patients/clients been denied reimbursement by a healthcare plan for services you rendered before, on or after January 1, 2014? Before Jan. 1, 2014 On or after Jan. 1, 2014 Don't know Question Title * 12. Have you experienced any of the following issues for services you provided on or after January 1, 2014? Reimbursed for services, but at lower than the billed rate Refused reimbursement when credentialed for a healthcare plan Been unable to apply for healthcare plan credentialing Had medical necessity of your treatment plan questioned/denied Other (please specify) Question Title * 13. Any specific healthcare plans you've had difficulties with since January 1, 2014? Question Title * 14. If you or your patients are willing to speak with us in further detail regarding any denials of insurance services since January 1, 2014, please provide contact information here: Question Title * 15. Do you collaborate with local MDs/DOs? No Consult Refer Co-manage Work collaboratively in same location Other Other (please specify) Question Title * 16. Do you partner with local hospitals? Yes No Done