Quoting Insurance Benefits

We are often asked to be able to "quote" what the benefits will be for a patient's insurance coverage prior to treatment with a provider. That process has changed dramatically over the years and it is now almost impossible to pin down. Insurance cards sometimes list an office copay benefit but that would only apply to a regular physician's office visit and not any type of specialty, like Psych. On-line access to benefits is an option for some insurances and will usually spell out the regular coverage. Some require a username and password to be set up to be able to go on-line and those also expire every 90-days or so and have to be kept in a secure location for HIPAA requirements. We actually have devoted entire shared, secured documents to just the handling of on-line usernames and passwords.

If you are able to get a quote on the benefits and the patient portion that they will owe, you still have to give a disclaimer to the patient that these are only a "quote" on the time they were checked or with the person you spoke to. I have seen where office staff have diligently gotten a quote, only to find out that the tax id or NPI of the provider was not given therefore extremely changing the amounts of coverage. We always remind office staff to never tell the patient that they will owe nothing or that their insurance will take care of the bill, as this information can lead to billing surprises down the road and unhappy patients.