# Does new insurance mean new patient??



## mfredericks73 (Jan 7, 2016)

I was told by a provider that when a patient obtains a new insurance, they are billed as a new patient (regardless of when they were last seen).  The provider agrees that if someone hasn't been seen for three full years that they are a new patient. However, they have also been told that even if a patient was seen a month ago, if they have new insurance, they are billed as a new patient because they have new insurance.
I have never known this to be true, and I cannot find any support for this. 
Can anyone let me know if you have any information about this???

Any help would be appreciated!


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## d_imparato (Jan 7, 2016)

mfredericks73 said:


> I was told by a provider that when a patient obtains a new insurance, they are billed as a new patient (regardless of when they were last seen).  The provider agrees that if someone hasn't been seen for three full years that they are a new patient. However, they have also been told that even if a patient was seen a month ago, if they have new insurance, they are billed as a new patient because they have new insurance.
> I have never known this to be true, and I cannot find any support for this.
> Can anyone let me know if you have any information about this???
> 
> Any help would be appreciated!



To my knowledge, the patient's insurance does not have anything to do with if the patient is considered new or established.  If the patient has not been seen within a 3 year time span then he/she would be considered a new patient for the physician.  There is a decision tree in the front of your CPT book to help you determine the status of the patient.  Some providers need to see the information in writing so I would show the provider the decision tree.  It also depends on if you work for a group of physicians and if so, is there different specialties within the group.


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## staciewatie (Jan 7, 2016)

*Definitely not*

If you look in the CPT book under the definition of a new patient, it says: "A new patient is one who has not received any professional services from the physician/qualified healthcare professional or another physician/qualified health care professional of the EXACT same specialty and sub-specialty, who belongs to the same group practice, within the past three years." If necessary, you could show the provider in the CPT book the definition of a new patient. It does not say anything regarding insurance when determining a new patient.


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## mfredericks73 (Jan 7, 2016)

Thank you for your input. I have referred to the information in the CPT book, and I have never known a patient to be deemed new just because of their insurance changing.
I appreciate the confirmation.


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