Many people don’t realize how important giving the correct insurance information at the time of service is. It can create great headaches for the Practice and the patient. When the Office does not have the correct information and a claim is billed to the wrong insurance company it starts a chain reaction, which ultimately ends up to the patient’s responsibility.
Let’s start at the top:
- Patient checks in at the window and does not update the sheet for any patient changes and marks same.
- Provider sees the patient and a claim is created.
- Billing looks over the claim to see whether the claim needs special attention according to the insurance company such as a needed authorization attached, medical notes, or accident date on the claim. (this really depends on each insurance company, example Medicare, Wcomp, auto, or commercial insurance all have different requirements.) The biller is assuming the claim is correct due to do patient update, so at this point the Provider has spent the time to see the patient, the biller has taken time to review the claim or charges and file the claim.
- The claim is sent to the insurance company. The insurance company can take anywhere from 30-45 days to process the claim and sometimes much longer, only to receive a denial for the claim stating it has rejected, because the patient does not have coverage at the time of service.
- Now the provider has to work the denial and try to research if it denied in error or not. Upon researching the claim the patient didn’t have this insurance at time of service and then the balance gets transferred to patient responsibility.
- The patient’s receives a bill and is not happy.
Needless to say there is a lot of time, effort, and resources to bill an insurance company and if you have several patients a day that do not give the correct insurance update then there is a lot of time and money that is lost.We at Central Florida Pain Management are very grateful for all who on conscious of their current insurance and make an effort to update it. Thank you.
Kay Ouellette, CPC