Author Topic: Benefits/Deductible  (Read 1345 times)

TammyL

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Benefits/Deductible
« on: October 31, 2016, 11:55:57 AM »
Just curious on how do some of my fellow billers keep up with the verification of benefits and how do you know when they have met there deductible to keep the patient from have a  credit on there account like for example we check benefits in Sept and deductible was 750.00 then in Oct they met there deductible but we had no ideal it was met because it was only checked 1 time

Michele

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Re: Benefits/Deductible
« Reply #1 on: October 31, 2016, 12:58:19 PM »
We don't do benefits verification for our providers.  Too difficult for us on the billing end.  We know the deductible has been met when the eob comes in.  We don't call to check.  Sorry, I know that's not much help.

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kristin

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Re: Benefits/Deductible
« Reply #2 on: October 31, 2016, 08:14:13 PM »
If you are going to collect money from a patient at time of service, you have to do three things to avoid collecting too much, and then having a refund due back to the patient:

1. Check their benefits the day they are seen, so you know how much deductible is left, and if they have co-insurance amounts they pay
2. Know what the allowed amounts are for each charge, so that you charge them the right amount up front
3. Submit their claim that same day

Even with doing those things, there will still be times you will have to refund the patient, because you may check benefits in the morning when the patient is seen, and by that afternoon, another claim for another doctor has processed through, and changed everything.


PMRNC

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Re: Benefits/Deductible
« Reply #3 on: November 01, 2016, 11:12:47 AM »
I do verification of benefits as a billing company, I think it's the best and first step in the reimbursement process so someone NEEDS to do it. My pediatric practices have financial policies in place for pay-down deductible payments for the larger deductible plans on the exchange market or individual plans. We verify benefits. If a carrier tells us that a deductible has NOT been met, we ask the patient to either bring us a check for the full amount up to their deductible or bring in an EOB to show that their deductible for that calander year has been satisfied. Insurance carriers won't (not supposed to) tell you how much a patient has to go to satisfy the deductible, they can only tell you the deductible amount and yes or no it's been satisfied. That's to prevent fraudulant billing (for example if a carrier says a patient has $125 left to meet their deductible, they might increase the fee of a service to $250 or any other amount higher than the patient needs to satisfy the deductible and increase reimbursement.)

The practice should have a clear office P&P that outlines who is responsible for benefit verifications and the process in which to do them. Make sure your office's financial policy is also up-to-date and outlines a patient's responsibility upon check-out of each visit which really helps collect up-front.  The office financial policy should also outline a patient's responsibility plus offer any additional payment plans or options.
Linda Walker
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kristin

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Re: Benefits/Deductible
« Reply #4 on: November 01, 2016, 06:44:52 PM »
Quote
Insurance carriers won't (not supposed to) tell you how much a patient has to go to satisfy the deductible, they can only tell you the deductible amount and yes or no it's been satisfied.

I never knew this, because whether I verify insurance through a website, or by speaking to a person at the insurance company, they always tell me(even when I don't ask) how much of the deductible has been met for the year, down to the penny.

PMRNC

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Re: Benefits/Deductible
« Reply #5 on: November 02, 2016, 09:22:58 AM »
Quote
I never knew this, because whether I verify insurance through a website, or by speaking to a person at the insurance company, they always tell me(even when I don't ask) how much of the deductible has been met for the year, down to the penny.

This can be confusing.. and a bit "psychological" <g> I worked with 3 of the top 5 insurance carriers as a claims examiner, we can tell you HOW much has been satisfied, we can't tell you how much is needed, so that's the difference, should have explained that better.   The same goes for things like U&C/R&C. A carrier can tell you a fee is within U&C/R&C but cannot tell you what U&C/R&C is. Those are not disclosed to prevent fraud. There is more chance of fraud if the carrier says "Mrs. Smith has to satisfy $50 more of her deductible for the calander year" than there is saying "Mrs. Smith has satisifed $200 of her $250 deductible". It's also logistics.. they can't tell you what is needed or what is going to be applied as that's looking into the future, they can tell you what HAS happened (amount satisfied).  Hope that helps a bit.
Linda Walker
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rofakamrd

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Re: Benefits/Deductible
« Reply #6 on: November 17, 2016, 11:01:06 AM »
i have never heard of an insurance co not telling how much of ded has not been met.... i check benefits all the time for my clients and it is almost always listed!... doesnt matter how much is charged to pt/ins they are only going to apply their allowable to deductible, at least , in ri... just a fyi... our medicare clients even show deductible met...

Michele

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Re: Benefits/Deductible
« Reply #7 on: November 17, 2016, 12:12:13 PM »
I personally have never run into that either.
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PMRNC

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Re: Benefits/Deductible
« Reply #8 on: November 17, 2016, 12:49:37 PM »
Believe me after having worked at 3 carriers they are NOT supposed to tell you what amount is LEFT to satisfy the deductible. This is to avoid providers marking up pricing to meet the deductible and profit. IF you have been told what's left, they are  not supposed to be telling you and your getting lucky. Also what about claims that are in the process of being processed. For example if a rep told me that there was still $100 left to be satisfied at the time I called, claims came in during that period before I sent my claim, the amount left they quoted you is incorrect. I'm sorry I find it hard to believe carriers have given you the amount "left" to satisfy. YES they will tell you the deductible is $500 and that yes or no it's been satisfied.

Linda Walker
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kristin

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Re: Benefits/Deductible
« Reply #9 on: November 17, 2016, 09:59:13 PM »
Believe me, they do say more than that. Typical conversation with an Aetna rep, for example(but it can be UHC, BCBS, Cigna, Humana, whoever):

Rep: "The patient has a $500 deductible, and they have met $420 of that deductible to date, with $80 remaining to be met".

I get that that means by the time the patient comes to our office, that $80 may have been met, with other claims coming through. Which is why we don't collect upfront. But the fact still remains, that both verbally, and in print(through Availity, Navinet, etc,), the deductible amount left to be met to date is clearly stated.

Michele

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Re: Benefits/Deductible
« Reply #10 on: November 18, 2016, 11:13:36 AM »
I'm wondering if it was just specific to the carrier you worked for Linda, because I worked for Metropolitan, UHC and Travelers and I was never told that. We gave that information out regularly.  Also, on Connex it lists the deductible amount and the amount remaining for the current year. 
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