Unfair Policy

July 1, 2005

One of our big payers recently told us that it will be requiring additional group coverage information on claims that may not be available on the patient's insurance card. We will have to call the plan administrator prior to filing the claim to get this information. Of course, there are no plans to send beneficiaries new cards that would include the needed data points. What can I do? I can't afford to have staff on the phone all day.

Question: One of our big payers recently told us that it will be requiring additional group coverage information on claims that may not be available on the patient's insurance card. We will have to call the plan administrator prior to filing the claim to get this information. Of course, there are no plans to send beneficiaries new cards that would include the needed data points. What can I do? I can't afford to have staff on the phone all day.

Answer: It's a crazy world we work in, no? One suggestion is to track the time you spend on this and bring it up when you renegotiate, saying you'll need more pay to recover the hassle factor - not a great solution, but it's something.

You certainly can contact other practices in your area and circulate a petition requesting a change in policy, new beneficiary cards, or at least easy Web access to the information.

You also could try to make it a nuisance for the payer by calling to request all numbers for all patients coming in all of next week in one sitting.

Or call your rep and ask her for the info every time you need it, just to get the point across.

Consider a letter to your state insurance commissioner and state medical society with formal complaints copied to your rep and whoever is in charge of provider relations at the corporate level.

In other words, be the squeaky wheel.