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Wiki deductible for complete surgery
- Thread starter krainko
- Start date
btadlock1
Guest
Staged procedure? If so, try splitting the claims up into 2010 service dates on one, and 2011 on the other; then send a reconsideration request/corrected claim, advising that services provided in 2010 should be processed for payment utilizing the benefits that the patient had on each service date (for which I'm sure you verified coverage), and not their benefits at the time of adjudication.
As for the 2011 dates of service; if they're subject to a new deductible, then they're going to have to pay it. A lot of people don't know anything about their insurance coverage, and forget about deductibles (if they even know they've got one). It sucks for patients whose treatment came with bad timing for their insurance coverage, but in the future, you can spot these situations ahead of time, by considering their current plan when you're verifying coverage - did they have a deductible to meet this year? If so, it's not likely to disappear next year. Let the patients know that they're going to be responsible for a portion of the procedure well ahead of time, and you can establish a payment plan with them, rather than shock them with a large bill after the fact. They're going to have to meet that deductible sometime, anyways - might as well get it over with early. Hope that was some help...
As for the 2011 dates of service; if they're subject to a new deductible, then they're going to have to pay it. A lot of people don't know anything about their insurance coverage, and forget about deductibles (if they even know they've got one). It sucks for patients whose treatment came with bad timing for their insurance coverage, but in the future, you can spot these situations ahead of time, by considering their current plan when you're verifying coverage - did they have a deductible to meet this year? If so, it's not likely to disappear next year. Let the patients know that they're going to be responsible for a portion of the procedure well ahead of time, and you can establish a payment plan with them, rather than shock them with a large bill after the fact. They're going to have to meet that deductible sometime, anyways - might as well get it over with early. Hope that was some help...
eadun2000
Expert
I can tell you that my personal insurance includes anything paid toward a deductible in the last three months of the previous year (last quarter) it is carried over to the new year. For instance, if I had a surgery done in November 2010 and had to pay $500 towards my $1500 deductible, then come January 2011 my deductible to meet is only $1000. You may want to check and see if any of the patients deductible from the previous year (quarter) transfers to the new year. If not, then the patient is still responsible regardless. I would talk with the patient before hand and see if you can work out a payment plan with them. Especially with the economy being as bad as it is, a lot of people do not have that type of money to pay all at one time (obviously if they have a high deductible). Just my two cents. Hope it helps.
Thank you for your quick input, I really appreciate it. The patients, my sister, insurance was up to date in 2010 and continued into 2011. Her breast cancer surgery started in feb of 2010 and due to surgery complications/ infections it continued into march 2011. Due to these complications, she ended up having a total of 7 surgeries in all. Her deductible is 2500.00 with a 2500.00 coinsurance, not something she can easily meet or hopes to. All the same, I really appreciate your input, so let me ask you, do you think I could argue this with Aetna? Since they crossed over global days,do you think they will consider it all toward the one 2010 deductible? Or is a new year a new deductible regardless? thanks, look forward to hearing from you
btadlock1
Guest
I would try to fight it. Ask for written disclosure on their policy for staged or related procedures. I could understand trying to package all of the services into one, if she were an OBGYN patient, having a baby in the new year, but complications of cancer treatment aren't predictable. She had no control over the fact that she wouldn't be better by the start of the new year; all of the services provided in 2010 should be subject to her coverage available on the date the services were rendered. Good luck!