Re: Insurance Verification

January 10, 2011

,

I'm using Phreesia, and the marketing is only the last screen of the whole interview, and is fairly "informational" in nature, not so blatantly advertising. The patient does not have to read it -- can simply "exit" out of that screen and hand the Phreesia pad back. You might want to have a demo to see if you find it offensive -- I don't. The numbers they can cite of increased revenue and the avoidance of the situation you're describing are pretty impressive.

Deanna, FNP

I am interested to know how everyone verifies insurance coverage onpatients. I ask because I am getting more and more letters frominsurance companies stating the office visit charges I submited won't bepaid because the patient was not eligible on the date of service. Morethan likely, this then turns out to be a free visit, because of theexpense of trying to find the correct insurance and rebill or thepatient ends up not paying at all. I do ask patients if their insurancehas changed and sometimes patients will let me know that it has. Still,a lot of patients do not, either because they forgot or don't want me toknow.I have been looking online at companies that offer verification, and Icame across Carevault. Does anyone use them? Are they expensive? Arethere any other companies that could be recommended? I really don'twant to get into Phreesia, as I don't want any marketing to my patients(which is a shame, because the credit card swipper and the IMH-likeinterview looks like a great idea). I'm sure a lot of doctors verifycoverage by either calling the insurance company or going to theinternet. I know that would be the cheapest way, but I bristle at theidea of having a bunch of website addresses and passwords to remember.I sure would appreciate any wisdom anyone could share with me.thanks, Sieberg, M.D.solo FM, Decatur, IL

January 11, 2011

,

Most of the insurance companies will give

you a user name and password and it is completely free. It is a pain to

keep each user name and password separate, but I tend to have them be similar

or the same, so it’s not too many to remember. Gateway EDI also has

insurance eligibility checks, but I find that the insurance company eligibility

is most accurate and easier to prove to the patients (yes, I give them a

printout) when the insurance info that the patient gives me isn’t

correct. If it was some off-brand website, the patient would likely

dispute it. If you are using electronic filing, you might check with your

clearinghouse to see if they offer insurance eligibility checks.

I have found that if it has been more than

6 months since we last saw a patient that it is best to ask the patient to

present their “most current” insurance card. Some patients

aren’t even aware that their spouse slipped them a new card.

Surprising, I know! If it has been less than 6 months, I will say “Do

you still have the Anthem Blue Cross HMO insurance?” That gives

them more of a clue than, “Has your insurance changed since your last

visit.” I’m still surprised that many patients believe that

the insurance companies give US their current information. Mind

boggling!!!! Since changing the question that I ask the patient, fewer

changes slip through the cracks, and I have much fewer denials for eligibility

reasons.

Somewhere in your paperwork that new

patients sign, they should be agreeing that they are financially responsible

for visits. That means that if their insurance doesn’t pay, they

will pay you. Then bill them and follow up with collections, if

necessary. I have found that sending a separate letter when I receive the

denial from the insurance company, which includes the insurance information

that we have on file, and mailing it to the patient along with a bill is a

pretty expedient way to get them to give me the correct insurance information.

Our EMR makes it easy at check-in to know

if the patient’s insurance information is current (in the past 3-6

months, I believe). We can also run reports so that eligibility can be

done well in advance, or even just a day before. I usually check

eligibility during the day, as we see patients.

Good luck,

Pratt

Office Manager

Oak Tree Internal Medicine P.C

www.prattmd.info

From: [mailto: ] On Behalf Of drsieberg

Sent: Monday, January 10, 2011

3:27 PM

To:

Subject:

Insurance Verification

I am interested to know how everyone verifies insurance coverage on

patients. I ask because I am getting more and more letters from

insurance companies stating the office visit charges I submited won't be

paid because the patient was not eligible on the date of service. More

than likely, this then turns out to be a free visit, because of the

expense of trying to find the correct insurance and rebill or the

patient ends up not paying at all. I do ask patients if their insurance

has changed and sometimes patients will let me know that it has. Still,

a lot of patients do not, either because they forgot or don't want me to

know.

I have been looking online at companies that offer verification, and I

came across Carevault. Does anyone use them? Are they expensive? Are

there any other companies that could be recommended? I really don't

want to get into Phreesia, as I don't want any marketing to my patients

(which is a shame, because the credit card swipper and the IMH-like

interview looks like a great idea). I'm sure a lot of doctors verify

coverage by either calling the insurance company or going to the

internet. I know that would be the cheapest way, but I bristle at the

idea of having a bunch of website addresses and passwords to remember.

I sure would appreciate any wisdom anyone could share with me.

thanks,

Sieberg, M.D.

solo FM, Decatur, IL

January 11, 2011