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Benefits/Deductible

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PMRNC:

--- 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.

--- End quote ---

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.

rofakamrd:
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:
I personally have never run into that either.

PMRNC:
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.

kristin:
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.

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