A patient has received new coverage but hasn't received an insurance identification card as yet. How should you file a claim on a patient who has new coverage?
Preferably, when patients call to make appointments you should have someone in your office corroborate their insurance coverage and eligibility, more so if you know the patient is going to have new insurance.
The start of the year is the time when benefits verification tends to be most useful. While verification is good practice all year long, January is the time when you will see more insurance charges – including payer, benefit, and deductible/copay changes than at any other time during the year as most employers hold open enrollment in December.
Finding out about insurance changes before the appointment gives you time to check if you're a participating provider with the payer and verify coverage. If the patient does not have an identification number with her new insurance company, ask for the name of the insurer and the policy number from the patient or from the patient's employer. After this, call the insurer and verify the coverage and the date of eligibility, and get the proper information to identify the patient on your claim.
Note of caution: The date of eligibility is an important question to ask the payer as many employees do not make health insurance coverage immediately available to new workers. A patient with a new job and new insurance may be in your office for a visit; however his insurance is not effective for two months.
Option: Even though verifying coverage beforehand is the way to go, many practices have patients corroborate their insurance coverage and note any changes when they check in for their appointments. If you are not able to verify the insurance coverage, or you find the patient's not eligible for coverage on the day of the visit, inform the patient of the problem and ask if he wants to reschedule the appointment (unless it is an emergency visit). Or else, explain to the patient that the visit and services may not be covered, and that he must pay the bill himself. Have the patient sign a waiver stating that the services rendered that day may not be covered by the new insurance, and that he's responsible financially. You should keep the signed waiver in the patient record.
Preferably, when patients call to make appointments you should have someone in your office corroborate their insurance coverage and eligibility, more so if you know the patient is going to have new insurance.
The start of the year is the time when benefits verification tends to be most useful. While verification is good practice all year long, January is the time when you will see more insurance charges – including payer, benefit, and deductible/copay changes than at any other time during the year as most employers hold open enrollment in December.
Finding out about insurance changes before the appointment gives you time to check if you're a participating provider with the payer and verify coverage. If the patient does not have an identification number with her new insurance company, ask for the name of the insurer and the policy number from the patient or from the patient's employer. After this, call the insurer and verify the coverage and the date of eligibility, and get the proper information to identify the patient on your claim.
Note of caution: The date of eligibility is an important question to ask the payer as many employees do not make health insurance coverage immediately available to new workers. A patient with a new job and new insurance may be in your office for a visit; however his insurance is not effective for two months.
Option: Even though verifying coverage beforehand is the way to go, many practices have patients corroborate their insurance coverage and note any changes when they check in for their appointments. If you are not able to verify the insurance coverage, or you find the patient's not eligible for coverage on the day of the visit, inform the patient of the problem and ask if he wants to reschedule the appointment (unless it is an emergency visit). Or else, explain to the patient that the visit and services may not be covered, and that he must pay the bill himself. Have the patient sign a waiver stating that the services rendered that day may not be covered by the new insurance, and that he's responsible financially. You should keep the signed waiver in the patient record.
