Today a patient walked into our office with an Explanation of Benefits from her insurance company for a service that was denied after we had checked her benefits and were told by the insurance company representative that it was covered, sound familiar? This patient wanted to know why we had told her that this specific piece of durable medical equipment was covered when it was not. Of course we had verified the patient’s benefits in advance and did document who we spoke to, the time of the call, and what was said so we could reference the call, but our patient’s concern was that she was told by our office staff that the item was covered, so it has now become our problem. We in the medical field know that fighting with insurance companies over claims consumes a great deal of staff time, which equals money spent on trying to collect on valid claims that should be paid the first time billed. Is there a better way to handle these type of situations that would make the patients more involved and therefore more responsible for fighting unpaid claims? I certainly think that there is, and it is making the patient more responsible for understanding their insurance coverage, and therefore having them as an advocate when these situations arise.
I was just visiting my Aunt last week on the east coast (D.C. area) and she asked me if I could help her figure out how she could get reimbursed for medical bills that she had paid out-of-pocket, but now needed to bill her insurance company on her own. Being from the west coast I asked her “why didn’t these providers bill your insurance?” and she told me that most providers do accept or bill insurance and that the patient is required to pay up-front and then if the patient wants to be reimbursed that they then bill their insurance company. WOW! what a great idea! why don’t we do the same here on the west coast? It was amazing to me that the insurance she has is for Federal Employees, and providers will not bill them. Well, maybe someday we might all get back to this type of system, but for the time being we need to make sure that our patients are more involved in knowing what their insurance covers and what it does not. The link below is a great site with a wonderful article that our office plans to have available to all of our patients. The article is about patients need to have knowledge about their insurance in order to be able to understand it and accept the battle when a service has been wrongly denied. By having this information available to patients it will put the responsibility and power back into their hands and remove it from the healthcare provider. Not to say that we do not work with patients to find out about their benefits before a service is rendered, but patients do need to realize that physicians cannot accept full responsibility and take losses when insurance representatives mis-quote patients benefits to us. Print up this article and give it to your patients so they can educate themselves on their insurance benefits.
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