Reduce Surprises: Patient Insurance Verification and Financial Responsibility Policies
Healthcare costs are rising, putting more financial burden on your patients and you. So how can you tactfully address this issue with your patients?
Posted in Risk Management on Wednesday, June 13, 2018
Addressing financial issues can be sticky. It requires the right tone, so as not to offend. However, if you educate the patient about why a fee is due, you may get their buy in to pay for the care.
For example, a patient received a call that $525 was due immediately for a CT scan scheduled in one week. There was no explanation as to why the amount was due—just that that the scheduler would wait while the patient retrieved their credit card. Could this have been handled better? Absolutely!
One way to address this issue is to establish a practice policy that addresses the patient’s financial responsibility. This helps create consistency and avoid surprises for the patient.
Because a patient’s healthcare coverage may change, share your financial responsibility policy with the patient each year. Provide a copy of the policy to the patient and place one in the chart. If a patient refuses the copy, document that in the chart. You should include your financial responsibility policy in your new patient packet and document that the patient received it.
When creating your policy, keep in mind that you want your patients to continue to seek healthcare treatment from you. Remind them that you appreciate them choosing your practice, and you are committed to their care. You don’t want them to avoid treatment for financial reasons—especially if the care is critical—or switch to another provider.
Consider including the following in your financial responsibility policy:
- The fact that it is in the patient’s best interest to understand their insurance plan benefits, and it’s their responsibility to pay for deductibles, coinsurance and copays. Questions regarding their coverage should be directed to their healthcare plan.
- Patients should verify with their healthcare providers whether your practice is a participating provider in their plan. They may incur more financial responsibility with “out-of-network providers.”
- When payments are due—usually the date of service, unless prior arrangements are made.
- When copayments and deductibles are due—usually at the time of the visit.
- Confirmation that insurance quotes, copays, deductibles and coinsurance may be estimates only.
- What types of payment are accepted at your practice:
- Credit cards (which ones), including flexible spending credit cards
- Debit cards
- Checks (perhaps for established patients only) and any cost for returned checks
- Who is responsible for payment of fees
- What information you will need annually and at each visit, e.g., their current insurance card and a photo ID.
- What financial assistance you can offer the patient, such as Care Credit and reduced fees for self-pay.
- Your policy on collections, including when accounts might be turned over to collections and what additional costs might be incurred, such as interest, handling and legal fees).
- The charge, if any, for missed appointments.
Here are some sample policies and things to consider:
https://www.aafp.org/fpm/2004/0400/p17.html# http://www.ada.org/~/media/ADA/Publications/Files/patient_54.pdf?la=en http://www.ada.org/en/~/media/ADA/Publications/Files/ADA_PatientSmart_Insurance