"What do you suggest I do when we can't get coverage information from the patient's insurance company? There are too many misunderstandings and upset patients and staff when the first check arrives.
You've got several more problems that you didn't mention that are creating this situation. No one is in charge of, and actually responsible, for getting this information quickly. You have a "fuzzy," or perhaps nonexistent, office policy on financial responsibility, and there's a lack of training or coaching for your staff. Fixing these will go a long way towards reducing the problem to an acceptable level.
The easiest place to start getting information is on the first phone call to your office. Most clinics ask if the patient has insurance and may note the company or type of insurance, but don't bother to get complete information. By getting all the information you can before they ever hit the door, you often have time to find out their exact coverage and determine their personal responsibility. We need to have a complete understanding of the patient's coverage as soon as possible to keep the patient's responsibilities correct and current.
If you are unable to determine coverage before they arrive, you need to have a specific payment and/or deposit policy for the first (and following) visits. You can determine how much that amount(s) should be by asking yourself, "How much am I willing to lose and/or gamble on this case?" The difference between that answer and your actual fees is the minimum amount you'll need to get as a deposit and payments on account.
Once this fee is determined, everyone in the office who discusses fees or collects money needs to understand and follow the policy. Don't forget to decide what happens if the patient overpays. Will you give back the overage or put it against unpaid balances on their account? Be sure you tell the patient at the time you work out their financial arrangements how you and they will handle this situation.
Be sure to also talk with them about what happens if their insurance company doesn't do what they say they will do. For instance, they pay less than expected, put the case in review without notifying you, or any of the things that make us crazy. You want to do whatever you can, in advance, to have the patient on your side before problems develop. If the insurance company "messes up," remind the patient that even though you might have accepted assignment, it's the patient who has the relationship with the insurance company, not your office.
One of the best ways to get information, if the company is not cooperating, is to get the patient actively involved. In all these situations, follow your "insurance call script." With the patient (or their spouse) in the office and on the phone to the insurance company, you or a CA/CT can coach them about what questions to ask. If the patient is willing, but unable, get on the phone or an extension with the patient, have the patient ask the insurance company to give you the information you need while they remain on the line.
The insurance company is far less likely to balk under these circumstances. And, if they do, the patient can see the problems that you are dealing with, and may be more understanding of your need to keep their account finances under control. If it's hard to get the patient, your insurance person and insurance company all together at the right time, try three-way calling. You can get this situation under control so that everyone, including the patient, will know what's going on. Good luck!
If your office would like a sample "insurance call script," send a stamped, self-addressed envelope to me at:
Grosse Pointe Park,
Grosse Pointe Park, Michigan