Ask an Expert: Navigating Complex and Changing Insurance Issues
From pre-authorizations to calculating procedure costs, here is what you need to know about the current era of high-deductible, bare-bones insurance.
With some insurance companies raising their
deductibles, what can physicians do to adjust?
In our practice, we are approaching insurance precertification and payments at the time of service quite differently this year than last. We have seen that an astonishing number of patients (somewhere in the 50 percent rate or higher) have 'bare-bones' insurances/health savings accounts. What this means is that many of these patients have up to a $25,000 deductible. Clearly, these are essentially self-pay patients and therefore need to be collected up front rather than once their insurances have been submitted and determinations have returned.
While there may be small differences between insurances payments and the amount submitted, it is wise to collect at least a significant portion of the payment in advance and/or obtain authorization for collection of the balance in the future.
How do you preauthorize insurances in your
We have one or two employees whose job is to query insurances on a daily basis prior to patient appointments. While this seems onerous, the downside of not knowing what patients will owe and the problem of not informing them in advance is a more significant issue in my mind. For this reason, we always find out the exact amount prior to performing procedures and then use that as a basis to inform the patients about the procedure costs and what their insurance will or will not pay.
Our billing system, NexTech, allows us to calculate costs quickly by entering in the charges. After they have been entered in, our office staff informs the patients of the charges and what their insurance deductible is and what has been met so far. While this is quite different from what we have always done, patients seem to be appreciative of the fact that we are addressing these costs in advance rather than after a visit. Additionally, most seem to understand the concept of paying at the time of service when they have a high deductible insurance plan.
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