A New Year Brings New Insurance Verifications

Mr. Smith has an appointment with your practice on Dec. 30, and a follow-up visit on Jan. 3. A month later, he receives a bill for the Jan. 3 appointment, but not the Dec. 30 visit. He calls your billing department and demands to speak with a supervisor: He wants her to explain why he owes money for Jan. 3!

It's simple, really. By the end of the calendar year, Mr. Smith had met his deductible and out-of-pocket maximum for his insurance plan, resulting in the plan paying at 100 percent with no patient cost share responsibility. On Jan. 1, his $3,500 deductible started over resulting in his plan applying the contracted deductible rate as patient responsibility.

Mr. Smith listens, understands, but has just experienced a poor customer service experience and will remember this over the excellent care you provided him at his appointment. This does not have to be the case! This type of scenario can always be avoided.

Typically the last week of the year, insurance companies will release the next year's plan details. It's up to your staff to make those phone calls or visit the plans' websites to obtain the next year's patient verifications. It is a laborious task, but a necessary one. Here are a few reasons why this is necessary:

• Employers often change plans without informing employees. Mr. Jones may have had Blue Cross this year, but next year, they may have UnitedHealthcare with a complete different set of benefits.

• As mentioned above, the patients' deductible will most likely start over. How would your front-office staff know what to collect at the time of service had they not re-verified the patient plan benefits?

Patient need to sign a new explanation of plan benefits at the beginning of each year, explaining what their cost responsibility will be. This will reduce the, "Surprise! You get a bill," statements and phone calls. This is the best way to eliminate a poor customer service experience.

As a provider, you are not required to provide this service to patients, but if the result is an overall happier experience, why wouldn't you invest staff time re-verifying benefits? Angry patients tell everyone about their poor experience. Happy patients refer their friends and family. Which would you rather have?