NEPA Vital Signs - Summer Fall 2017 - 32

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The Practice Management Perspective
INSURANCE TIPS

've seen many changes in the business
of health care since I began my career in
the early 1970s. One of the most baffling
for doctors, practices, and patient alike is
health insurance coverage. Medications that
were once covered by prescription are now
available over-the-counter, and paid for by
the patient. Durable medical goods such
as crutches and nebulizer machines are
sometimes not covered at all. Office visits
require co-pays, but is it the specialist or
the primary care fee? Making matters even
more confusing is the wide array of policies
available. At one time, I knew the contact
person at every one of the fifteen insurance
companies we dealt with. I was familiar with
the plans and what they covered. Today,
with literally hundreds of options available,
it's difficult for doctors' offices to know the
specifics of any given plan.
To protect yourself from surprises on your
bill and make the most of your benefits, you
have to be proactive. There are several things
you can do to help make your experiences
at the doctor's office go smoothly:

Know your policy!

How much is your deductible? A deductible is a set amount of money (typically
$500 or $1,000, up to as much as $5,000)
that the patient is responsible to pay before
insurance benefits kick-in. For example,
if you have a $1,000 deductible and your
doctors bill is $250, your insurance will deny
the claim by your doctor, and you will be
billed for the entire $250. You will be billed
again and again by all the doctors you see
until you've paid $1,000 in medical bills.
On the other hand, if your deductable is

Have the proper
identification!

$1,000 and your bill is $3,000, you will have
to pay the first $1,000 and the insurance
will pay the balance of $2,000. Even the
most comprehensive plans are beginning
Due to cases of fraud, insurance comto have deductibles.
panies require proper identification for
patients using insurance to pay for medical
Your deductible should be printed on expenses. A parent's ID is suitable for minor
the plan you receive from your carrier. If children. If you don't have your ID, the
you cannot find the information, you can doctor's office is not legally permitted to
always call your employer or your insur- treat you and bill your insurance, although
ance company. Knowing your deductible they may treat you if you pay cash.
will allow you to work with your doctor in
determining your plan of care. Explain to
your doctor that you have a deductible, and
ask if tests such as labs or x-rays are necessary, or just a precaution. Ask if waiting
Don't rely on your doctor's office to
a few days before getting tests done would have a copy of your insurance card. Combe okay. This can save you hundreds of puters crash, practices change software,
dollars, particularly if you are a person who and insurance coverage changes often.
doesn't go to the doctor often.
If you don't have your card, the doctor's
office may not be able to submit the claim
to your insurance company for your visit,
and the bill will come back to you. While
A network is a group of doctors, labs, you will probably ultimately prevail, it will
x-ray facilities and hospitals that accept be a huge headache to sort out the coveryour insurance plan, or are considered age in the end.
in-network. Your insurance is obligated to
pay your bills from these in-network faciliKeep in mind, it is legal to photocopy an
ties, so long as your deductible is met. When insurance card. Keep one at your house,
you venture out of network-even if you're give one to your spouse, all of your babysitreferred by your doctor-your bill may not ters and anyone else who is taking care
be covered. The first thing you should do of your children.
when making an appointment with a new
doctor is verify that they take your insurIf you follow these simple steps, you can
ance. And, since things are always changing greatly decrease your frustration when dealin healthcare, you should also check with ing with your doctor's office, and perhaps
every doctor you see. Just because your save yourself some money as well.
doctor accepted your insurance last time
does not mean he or she still does. A simple
error like that could cost you hundreds of CAROLYN BEERS is the Practice Administrator
dollars or more.
for Pediatrics of Northeastern Pennsylvania.

Have the proper
insurance cards!

Know your network!

N E PA

VITAL SIGNS

http://www.lackmedsoc.org

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