Medical Billing Forum

General Category => General Questions => Topic started by: ste on July 20, 2012, 04:35:29 PM

Title: verifying benefits
Post by: ste on July 20, 2012, 04:35:29 PM
What can be done when a particular insurance consistently gives misinformation? Whenever I complain they hide behind their disclaimer.
Title: Re: verifying benefits
Post by: DMK on July 20, 2012, 04:54:41 PM
If they have benefits or claim status online, print it out.  Or ask the customer service agent for a printout of the information.
Title: Re: verifying benefits
Post by: ste on July 20, 2012, 06:31:18 PM
On-line verification of benefits - Sometimes the specialty is listed as a benefit and other times the specialty is not listed as a benefit. This particular insurance does not list exclusions. Often times the patient does have the benefit eventhough it is not listed on-line.

Verifying benefits by phone - Given the possible unreliable nature of checking benefits on-line in cases where the specialty is not listed I am forced to rely on verifying benefits over the phone. Whenever I ask for faxed portions of the plan which state the specialty is an exclusion I am told by the insurance rep that this is something they cannot do.
Title: Re: verifying benefits
Post by: Michele on July 20, 2012, 07:49:40 PM
There really isn't any thing that can be done.  When calling to verify benefits be as specific as possible.  Ask for any documentation or online references.  Document date and time of call, who you spoke with and exactly what was said.  but in the end their recording "nothing is a guarantee of benefits.  Claim must be received and processed for benefits to be determined" keeps them from being held accountable.
Title: Re: verifying benefits
Post by: PMRNC on July 21, 2012, 10:30:54 AM
And there is good reason for that disclaimer that people don't realize. When you verify benefits before a time of service the patient could have coverage, when seen they may not and it's that simple. Whenever verifying coverage and benefits we are asking them to look into the future, think about it that way.  Anything can happen in that time so they cover themselves by telling us that "Verification of Benefits is not a guarantee of payment, benefits will be considered at the time of service".   They are also required by law to have that disclaimer.