As a medical office that bills insurance claims, this is what we could potentially look like on a daily basis. But in all seriousness, we call insurance carriers to verify benefits, out-of-pocket costs and treatment limitations for all our patients AS A COURTESY. This process takes anywhere from a couple minutes up to 30 minutes or more per patient.
We ask all patients to also call their insurance carriers once we send them the information that we are given so they too can verify their benefits, limitations and costs. Then, there will be no surprises once the claims are processed. Rarely does the patient actually call to verify and then, guess who gets yelled at when a discrepancy arises. Yep, you guessed it... WE do.
Here's a basic guideline of what a patient seeking medical treatment should do to be informed and avoid a lot of unnecessary insurance and billing headaches.
- Call your insurance company and let them know what kind of treatment you'll be seeking.
- Find out if there are any authorizations are required for the treatment you are seeking. For example, if you are a Tricare, Workers' Comp or Medicare patient, you will need a referral or prior authorization for physical therapy BEFORE treatment can start.
- Find out if there is a limit to the type of treatment you are seeking (e.g., limit of 60 PT visits per year) and if any treatment is not covered by your plan.
- Have a CURRENT copy of your insurance card ready to be copied at the office during your initial visit.
- Know your deductible for the CURRENT year and any applicable coinsurance or copayments you need to pay each time you visit.
- Understand whether your plan is a calendar year plan or what day/month your plan starts each year, so you'll know when the deductible starts over. For example, does your plan renew every year on January 1st or does it renew every October (or other month of the year)?
- Know whether you have a Health Savings Account (HSA) that will be used to offset some of your out-of-pocket costs and have the card on hand to make a payment at each visit.
And, MOST IMPORTANTLY...
- Communicate openly with the billing department so that any questions on claims can be answered and handled early on during your treatment rather than waiting until it's too late.
The billing department wants you to have a good experience both with the treatment you are seeking AND the billing. Open communication, preparation and teamwork are the best ways to achieve both!
