Do you know what's covered?
Nearly every day, patients ask me or one of my partners one of the following questions:
"Do you know which mail-in prescription plan I have?"
"Do I have a mail-in plan?"
"Is that specialist covered by my plan?"
"Does my health insurance cover that treatment?"
"Which pharmacy should I use?"
Our answer is almost always the same:
“As a good consumer, it's your job to know what your health plan covers.”
Knowing this information will make the patient's life easier because they will know they have to use a specific hospital, lab, or pharmacy.
They will also save money and a lot of headaches if they use physicians and providers in their network.
There's no way primary care physicians can possibly keep up with the intricacies of every plan. They are too far reaching and change much too often.
Patients only have to keep up with one plan . . . their own!!
This responsibility belongs to the patient or family and it makes them better informed and better consumers of their healthcare.
In addition, when they become dissatisfied, it gives them the perfect opportunity to vent their frustrations to the people who may be able to make a difference: their plan representatives.
The take-home advice is know your coverage, know where you can use it and don't wait until you need it to find out!
"Do you know which mail-in prescription plan I have?"
"Do I have a mail-in plan?"
"Is that specialist covered by my plan?"
"Does my health insurance cover that treatment?"
"Which pharmacy should I use?"
Our answer is almost always the same:
“As a good consumer, it's your job to know what your health plan covers.”
Knowing this information will make the patient's life easier because they will know they have to use a specific hospital, lab, or pharmacy.
They will also save money and a lot of headaches if they use physicians and providers in their network.
There's no way primary care physicians can possibly keep up with the intricacies of every plan. They are too far reaching and change much too often.
Patients only have to keep up with one plan . . . their own!!
This responsibility belongs to the patient or family and it makes them better informed and better consumers of their healthcare.
In addition, when they become dissatisfied, it gives them the perfect opportunity to vent their frustrations to the people who may be able to make a difference: their plan representatives.
The take-home advice is know your coverage, know where you can use it and don't wait until you need it to find out!
Labels: healthcare, responsibility
posted by Anonymous at 5:58 AM
5 Comments:
I work in the billing dept for a group of Cardiologists. We get this question all of the time also.
Like you, the only thing we can tell them is to contact their ins co. Plans are so intricate there is not way to tell in advance what will be paid for any procedure or even office visit.
I've work on both sides of the fence - as an insurance adjuster paying providers and as a medical billing person getting insurers to pay...AND I'm a lawyer specializing in insurance coverage work. I feel for people trying to not only understand the basics of their insurance policies but to resolve payment conflicts.
HB and SB, I hope your practices at least help folks out when a dispute arises between what you charge and what the insurance company will pay (I'm sure you do if possible).
I love it (sarcasm) when I go to the dentist, the dentist "accepts" my insurance plan, and then the dentist and the insurance plan get into disputes about what an appropriate charge is...and THEN I get a balance bill because they can't work it out.
Technically, this IS my problem, not the dentist's - and, fortunately, I know how to get them resolved to my favor using the jargon of the industry - but woe to the uninitiated.
It is nice when provider billing folks try a little harder to resolve these disputes for me. It's great customer service. Remember that.
Mr. Smith,
Does your law firm work out all the subsequent problems from a legal visit without charging the client for the time and effort?
That would be good customer service as well but it doesn't happen.
Physicians offices should charge for this service if the patients want it provided
Does your law firm work out all the subsequent problems from a legal visit without charging the client for the time and effort?
Wow - thanks for the anonymous broadside attack! I love the blogosphere. I was very specific about the scenario I described, "you" devolved into a cowardly attack.
If you will identify yourself and then be more specific about the "subsequent problems" from a "legal visit" I'll be happy to try and answer address your question. I'm guessing you have no idea what you are talking about, but please prove me wrong.
In addition, I'm proud of the work my firm does on behalf of clients, including the countless hours we spend doing pro bono work. Thanks for the comment and happy holidays. Tis the season.
Oh if it were a perfect world!
This topic really hit home for me. I am someone who has worked in the medical field both as a "hands-on" care giver as well as an administrator responsible for collections. And one would think that I would be very attuned to the nuances that surround the health care system. However, when one is the patient...everything changes.
When a patient visits his/her physician, the primary focus is the medical problem at hand. I cannot tell you how many times I have come away and been frustrated because my mind didn't think fast enough to ask for the generic version of a medication...or thought to ask for a substitute because the one ordered by the MD is not on the formlulary for my inurance....or asked for two prescriptions; 1 for immediate use and one for a 90 day mail order...or questioned if I could get a lab or xray performed at a free standing facility instead of going to the hospital as instructed by the MD. (Sometimes the results are needed faster than the freestanding facility can get them to the MD).
I am not expecting the MD, or his/her office staff for that matter, to know the current status of every insurance program. But it sure would be nice if the MD could help me to re-focus my thoughts from my illness and jog my mind with a few simple questions like:
1. Do you need a generic drug? Do you know if this is on your insurance formulary? Do you use mail order?
2. Will your insurance pay for this lab? xray?
3. Would you like a few samples to get you started? (This practice helps to offset some of the expense of the MD office visit.)
If a few simple questions are asked at the time of the MD visit, it might not be necessary to call the MD's office for changes in the original orders. I accept that not everyone will know his/her insurance plan's coverage, but for those who do, time will be saved for the MD and his/her staff. It also might prompt the patient to better understand his/her insurance prior to the next MD visit. At least the answers to the questions the MD asked.
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