InsuranceDeductibles & Verifications

Created: 9-13-13

The Goal:Clerical should NOT have to look at the insurance verification screen shot while

checking the patient in!!

The Plan:Alter our insurance verification process so that deductible information is more

accurate and readily available for check-in.

Make sure to:-Include multiple screen shots to make sure that ALL the necessary information is in the patient’s chart (the main information section at the top, the deductible information, and the physician – office visit section down below)

-Complete the e√ portion as usual, however, we will now be adding information to the “deductible, total” and “deductible, rem” boxes for all deductible insurance policies.

The information listed in the “Memo1 box” should match the informationin the “copay” box in the e√ !!If it is an insurance with a First Dollar amount, the “deductible, total” boxshould read “first dollar” until the patient has moved on to their personaldeductibles

-Examples to follow

Multiple Screen Shots:1. Ctrl+Print Scrn for the first image2. Add new insurance verification under patient information in the patient’s chart3. Clipboard at the top of the screen4. Ctrl+Print Scrn for the second image5. Arrows at the top of the screen, add, clipboard6. Continue steps 4-5 as many times as needed to get all necessary information

Example 1: Deductible then copay plan

Screen shot needs…

DemographicInformation

DeductibleInformation

“W” means benefits are the same whether you are in or out of network

Phys – O.V.Information

Example 2: Copay plan

“N” means out of network

In network

Out of network

PCP copay

Out of network deductible

Ins verification shows $25 copay and card shows $15 copay – so, we would want to make sure we scanned an updated insurance card!!

Insurances with a First Dollar Amount-These are BlueCross/BlueShield Aqua Plans

-The insurance company pays medical claims at 100% until they have exhausted the “first dollar amount”

-The patient then pays a personal deductible of the same amount

-Once the first dollar amount and the patient deductible have been exhausted, it changes to a 20% coinsurance – the insurance company will pay 80% of the allowable amount for the charges

-The Memo1 line should read “First Dollar/Ded/20% coins” until the first dollar amount has been exhausted and then it may change to “Ded/20% coins”

-If the patient is still meeting their “first dollar amount”, HealthEnet will not keep a running total of what remains (example on next page)

-If the patient is currently working on meeting their personal deductible after the first dollar amount, healthenet will show a running total of what is remaining. This is listed under the heading “First Dollar” (example to follow)

Example 1: First Dollar Amount

Example 2: Personal Deductible

Example 3: 20% Coinsurance

Exceptions:-Pt is not to be seen without paying their copay/coinsurance/deductible without billing’s approval

-Billing will make a #9 note, clerical must notate in the e-superbill notes

-If patient is unable to pay at time of service, please call billing with the following information:

-When can they pay?-How are they going to pay? (call billing, mail in payment, or come to whatoffice)

Reminder:Please tell patients to bring money for their copays/coinsurance/deductibles when scheduling their appointments!!!

Payment Arrangments:-When billing makes payment arrangements, the biller will put the agreed upon arrangement in the #9 notes. The note type is “PMTAR”

-Example: Patient has agreed to 3 monthly payments of $50 to take care ofthe $150 Transworld balance. First payment taken over the phone today.Last payment to be received no later than November 30th, 2013. Patientis aware they are responsible for all copays/coinsurances/deductibles for any appointments over the next two months on top of the monthly paymentand any missed payment will nullify the arrangement and enable them to goto legal collections. KE

-The biller will also put the arrangement in the admin note so clerical knows when checking the patient in.

-Billers have also started using the “to-do” function to follow up on payment arrangements.

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