News & Articles

NON-PAR CARRIER PAYMENTS TO PATIENTS

By Leigh Perry

In times past, insurance carriers would send their payments to the provider whether he or she was participating or not. The one general exception was GHI. These days, even the larger carriers, such as Blue Cross and Blue Shield and United healthcare, are tending to send the payments to the members. This poses a problem for medical billers, particularly for office based anesthesia, since many patients are not aware that they will receive a check from their insurance. Often they are told by the "surgeon's" office that "it is all taken care of". The surgeon's office may not speak for the non participating anesthesiologist, but the patient is often not made aware of this.

When a patient receives an insurance check one of several things happen. They hold it for a bill, they cash it and wait for a bill, they cash it and don't care when a bill comes, they call the carrier to find out whom it is for, they return the check to the carrier, or they call the surgeons office and follow the directions given. There are also those patients who get the envelope from the carrier and thinking it another EOB, toss it aside or, even worse, toss it out. After all, they NEVER get checks from their insurance company, why would they even think to open the envelope and look inside?

The first thing you need to do is make certain that the patients who will most likely receive a check know you are out there and know there is a chance they will get a check from their insurance company. Give them your card at the time of service and follow it up with a letter advising them that if they get a payment they are to send it to you. This action will reduce the need for telephone follow-up, but it will not eliminate it.

The tricky thing about getting insurance money from some patients is to get them to understand it is YOUR money and not THEIR money. It is also not easy to get in touch with some patients because of their work schedule. In many cases, it simply is not productive to leave a HIPPA compliant message on their answering machine. There is so little information you can leave and many people are not "inspired" to return a call like that. Billing the patient helps, but again, it isn't enough. What you need to do is make telephone calls at the most appropriate and productive times on a case by case basis. This is where having a professional billing agency handle your work can be a huge benefit. If the agency is open in the evening and can receive and make calls to these patients, your income will increase and your need to send patients for further collection action will decrease dramatically.

It is never wise to assume that a patient will get a check from the carrier, know whom it belongs to and send it to that party immediately. Life happens. There are so many reasons why that check may not make it into your hands. Without proper intervention by a skilled billing representative, you risk losing a lot of money. You simply can't afford to be lax in this area, so if you do not have the time to follow up with the carriers and then the patients don't even begin the task.

An aggressive but friendly representative, who is responsive to the needs of the provider and the patient, is the best bet for collecting your money promptly. You need to remember that insurance carriers no longer are able to give full information about patient payments to anyone other than the patient. After you follow up with a carrier to see if a patient has been paid you must then take whatever information the carriers privacy policy allows them to give you and call the patient. If your information is insufficient they made need to call the carrier themselves, and it can be very difficult to convince them to call. After all, weren't they told at the surgeon's office that it was "all taken care of?"

If you are a provider that does not participate with major carriers, be aware that there is no guarantee you will get paid directly. Be prepared for a lot of phone work in order to get your money - or find an attentive billing agent that is open long hours and can make these calls for you in an effective and productive manner.

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