Do you know your insurance benefits?

We had a new patient in the office and we pulled up their insurance benefits coverage through their insurance provider. Their response was that they could not locate benefits coverage. We submitted an eligibility request for it to be further researched. One week later, AFTER the patient was seen as they were in pain at the time, the insurance company responded that they had a $20 copay as we were in network. One month later, the claim statement came to our office from the insurance company. It wasn’t processed with a $20 copay at all. It was processed against a deductible. The insurance indicated we needed to collect $45 per visit from the patient for the 3 visits they were in the office. When we pulled up their information again, it showed they had a $1,200 deductible. NOT the same information that they sent to us only 30 days prior. When we called the insurance company, they indicated there was nothing they could do. They simply apologized for the incorrect information being sent to us, but stated it was now processed correctly. Well, needless to say the patient was not happy. Fortunately the patient understood we did all we could.

Many patients think we have a say in their coverage, or benefits and/or how they are processed. We are also at the mercy of the insurance companies in being able to provide benefit information. We can only let you know what they provide to us. If what the insurance company provides us is different than your benefits, call the insurance! Refer to your Benefits Summary provided by the insurance company. You can also reach out to your HR representative for help with the insurance company. PLEASE! ALWAYS KNOW YOUR BENEFITS! CALL YOUR INSURANCE COMPANY AND HOLD THEM ACCOUNTABLE!

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