It’s a scenario you never want to find yourself in but somehow it happened: you just finished up an appointment with a new patient and at checkout, your office staff discovers the patient isn’t in-network and you’re not going to get paid.
It’s not something that happens every day, but despite your intake process, financial policy and office procedures, it’s always a possibility.
Part of the problem is that patients don’t always understand their coverage. A 2013 study published in the Journal of Health Economics found only14 percent of consumers with private health insurance had an accurate understanding of the terms deductible, copay, co-insurance and out-of-pocket maximum.
Another reason you might find yourself in this situation is that patients may ask if you take their insurance but fail to check whether you’re an in-network provider or not. Studies also show that the procedures in place to make sure a provider is in-network are not transparent or consistent.
Nevertheless, the are ways to collect payments if you discover a patient isn’t in-network, and more importantly, also prevent this problem from ever happening again.
1. Submit the claim
Depending on the type of coverage, the insurance company may pay a portion of the bill so always submit the claim in case.
When the insurance company makes their final decision, you can negotiate a payment plan with the patient or ask the patient to pay 50 percent and then call it even.
3. Get help
Rather than tasking your own billing department with collecting balances, work with a third party agency like carecredit.com which can help you collect payment at the time of service and decrease the costs and risks associated with billing, collections and bad debt.
4. Request payment upfront
To avoid seeing a patient who isn’t in-network and run the risk you won’t get paid, ask for full payment upfront. In fact, approximately 75 percent of healthcare and hospital systems practice point-of-service collections, or the practice of requesting payment when services are rendered, according to Richard Gundling, senior vice president at the Healthcare Financial Management Association.
5. Always confirm coverage before the appointment.
When your staff makes an appointment, they must verify insurance coverage for both new and existing patients because policies are constantly changing.
However instead of wasting time on the phone with insurance companies, Zocdoc’s Insurance Checker modernizes this outdated process. With Insurance Checker, patients can decipher their insurance card, select the right insurance plan and get verified plan details before they book. Patients simply scan their insurance cards, see their real plan names, confirm their eligibility status and in many cases, their deductibles and co-pays as well.
6. Give patients the billing policy
Before the appointment, have your office staff email or mail patients your financial policy and procedures and a reminder to bring their insurance cards and other important documents.
With a bit of extra time and effort to ensure all of your patients are in-network, you can continue to get paid on time and keep your practice moving forward.