One of the biggest issues a medical practice faces is getting patients to pay what they are responsible for. We are healthcare professionals and as such we deal with insurances everyday. The insurance jargon that is normal for us sounds foreign to the typical patient. From a patient's standpoint, they have a health insurance plan; they ask the practice to file a claim and the insurance company pays what the practice is due. However, you and I know that there is a lot more to it. There is a huge gap between reality and what the patient thinks happens with their insurance plan. Most patients do not understand that they must also understand the insurance plan they have. Does the plan have a deductible? Is there a copay or coinsurance associated with some visits and not others? What is the difference between a copay and coinsurance? Is the doctor in network? What is the difference between In-Network and Out of Network? Do they need authorizations to see a specialist or to have a procedure? The typical patient is truly not aware that this type of information is their responsibility to know and understand. We all have had the patient who comes in and says they have Medicare when in fact they have a Medicare Advantage plan or the patient who comes in with his insurance card to find that he no longer has that insurance. We should be verifying every patient's insurance each time they come in for a visit or at a minimum yearly, which means we know what the patient's insurance covers, if they have a copay or coinsurance, if they have a deductible and how much the deductible is, and if they need authorizations or not. There are several opportunities to inform clients of their financial responsibilities beginning with their very first encounter. People tend to be more receptive and …
By Marge McQuade
PAHCS
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Educating Patients about Their Insurance and Financial Responsibilities
Date Posted: Wednesday, March 23, 2016