This blog is in response to the following article:
LinkedIn.com Article – click here to read
In this article the writer goes over the the hurdles our healthcare providers go through to get paid for their day to day claims. Some of these hurdles are affecting our patient care adversely. In many cases even treatment plans are affected because insurance do not cover certain medications or procedures. This leaves our patient community in a healthcare limbo since the plan doesn’t “want” to pay for a service and the patient also does not want to be responsible. As the article goes on to indicate, many providers who were polled would like a single payer system. While we don’t necessarily agree with this assessment for our practice, we do believe our current healthcare hodgepodge helps only the health insurance community and not the patients or the doctors who render their services in good faith and in the best interest of our patients.
Our practice which has a large young and middle age patient population is plagued with the current HIGH DEDUCTIBLE issue. This means that our patients are responsible for the first $2000 to $5000 worth of medical services. In most instances patients don’t satisfy their deductibles before seeing one of our doctors. Many of them do not need that many services in a year. This causes a payment lag for the doctors services which in turn hurts the medical practice as a whole. Many patients are finding it hard to pay for medical services immediately once the claims have been processed.
Another issue discussed is related to the time and effort spent on trying to get the insurance plan to approve and pay for services and medications. This alone consumes several hours a week of the doctors’ and their staff. This time could be better spent caring for our patients. Add to that constant records requests and all sorts of questioning and second guessing the doctor’s judgement and yes, they go mad!
We’re interested in our patients and would like to see some progress in the healthcare machine that will put the patient’s health and the doctors’ efforts first. Our patients need care, our doctors need to be compensated for the care they provide. Web searches, deferred treatment and ER visits do not cut it. But thats the way things are going because of our current circumstances. Things need to improve.
One of the most common challenges for any practice during the beginning of the year is collecting in network deductibles (a set amount of dollars billable to the patient). Most insurance policy deductibles reset on January 1st every year. Many of our patients come to us early in the year, with that concern in mind. Medicare policies thankfully are simple enough, one deductible of $147.00 for the first claim or claims processed during the year.
For private insurance (Aetna, BCBS, Cigna, HIP, Oxford, United Healthcare) is a little bit more complicated. Private insurance deductibles are assigned in different ways, at times we wont know the specifics until a claim is processed. Some policies work like Medicare and deductibles are assigned to the first claim, regardless of the services on it. However, other policies are a bit more intricate and will assign deductibles based on type of service billed. Yes, patients have their booklets that inform them of potential deductible allocations however, this information sometimes is not detailed enough. Even when calling insurance to verify benefits, you wont know that while your policy will not have a deductible for your visit services, it may have it for medical procedures or for imaging services in the same date.
Its important for our patient population to keep in mind, that fees assigned to their Deductibles will be billed to them directly. We advise that they put aside some funds every year (some policies/employers provide Health Savings Accounts for that purpose) to address deductibles in their policies. This way those couple of hundred that might be billed to you will be easier to pay.
If you have any questions, please contact our billing office and we’ll go over your information.
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.