Practice Management Alert

Question: How should I file a claim on a patient who has new coverage but has not received an insurance identification card yet?

Minnesota Subscriber  
Answer: Ideally, when patients call to make appointments, you should have the appointment scheduler confirm their insurance coverage. This is when you find out if they have new coverage. Finding out about insurance changes before the appointment gives you time to check if you are a participating provider with the payer and verify coverage. If they lack an identification number with the new company, ask for the name of the insurer and the policy number from the patient, or from the patients employer. Then, call the insurer and verify the coverage and the date of eligibility, and get the appropriate information to identify the patient on your claim.
 
The date of eligibility is an important question to ask the insurer because many employers dont make health insurance coverage immediately available to new workers. A patient with a new job and new insurance coverage may be in your office for a visit today, but his or her insurance isnt effective for two months.
 
Although verifying coverage in advance is preferable, most practices have patients confirm their insurance coverage and note any changes when they check in for their appointments. If you are unable to verify the insurance coverage, or you find that the patient is not eligible for coverage on the day of the visit, inform the patient of the problem and ask if he or she wants to reschedule the appointment unless its an emergency or urgent visit. Otherwise, explain to the patient that the visit and services may not be covered, and that the patient must pay the bill. Make sure the patient signs a waiver stating that. By signing such a notice, the patient is notified that the services rendered that day may not be covered by the new insurance, and that the patient is financially responsible. Keep the signed waiver in the patient record.