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Avoid claim problems! Coordination of Benefits is the key.

Our office verifies all insurance policies for our patients.  As we go over several accounts,  the importance of up to date Coordination of Benefits becomes more apparent.  We ask all our patients, new and existing to please provide us with ALL INSURANCE information.  This includes our Medicare patients.

On occasion some patients ask “why are you asking for additional insurance? I use only this policy!”  It’s important to understand that there are some rules in place when it comes to having multiple insurance policies.  Unfortunately, even if we wanted to, as insured parties, we are unable to select which policy to use as primary insurance. When we have multiple policies insurance companies have methods in place to determine which of your policies should be your primary payer and which should be your secondary.  These rules apply to all insurance companies and will have to be determined through all insurance policies a patient has.  Once all insurance policies agree, then you have successfully setup your coordination of benefits and will know in which order to present your insurance information to your doctors.  This process may be cumbersome, but once you have set your Coordination of Benefits correctly, you save yourself and your doctors a lot of future hassle.

One of the issues many practices encounter most often is related to patients who do not disclose all insurance information or were not aware of additional insurance coverage.  These cases, while not many, tend to cause the most time-consuming problems from the administrative standpoint.  That is without mentioning all the financial liabilities the patient may face.  The problems arise when the one insurance the patient “always” used recognized their status as incorrect, after claims had been paid (some times a year after payment).  Following this, the insurance would initiate payment recovery procedures with the indication “We paid your claim in error, the patient was insured by XXXXXX at the time of service, please invoice XXXXXX”.  At this point it’s sometimes difficult to collect from the “correct” primary payer and we’re then obligated to collect from the patient.

When looking through the patient’s records we find that even though our forms request ALL INSURANCE be disclosed patients show only ONE CARD and fill in only ONE INSURANCE in their intake form.  At this point we need to collect from the patient because either their other policy is one we don’t belong to or because it’s now too late to submit claims to another insurance because of timely filing constraints.  In an easy case, the affected patient has just the one claim for the year.  On an extreme case a patient would have received services from multiple health care providers during a time frame that could span more than a year, now with thousands of dollars to account for.

For this reason we insist that as an insured party, its important that you disclose all insurance information as well as be sure that your policies are correctly coordinated.  This includes ALL PATIENTS.  As mentioned before, its not our choice which policy is primary payer, our local laws and the insurance make that determination.

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