Many of you have changed insurance plans. Some of you have the same plans, but your benefits have changed with the new year. We are excited because we’ve done most of our benefit checks, and we can move forward!
Here are a few things we need to let you know about insurance, and about how you can help the process of claims and billing run smoothly for everyone:
1. Multiple insurance policies.
One of the big questions we have for all of our clients is, “How many insurance policies do you have?” If you have more than one it is very important that you let us know about all of them, and provide us with cards for all of them.
Sometimes, we run into a situation where the husband and wife have separate policies. When it comes to billing for your child, one of these policies will be primary, and the other will be secondary. This is determined by whichever parent has the birthdate that falls earlier in the year. If the wife’s birthday is in April and the husband’s is in August, the wife’s insurance policy will be primary and the husband’s will be secondary.
If you only provide us with information on the secondary policy, we will only bill to that policy. But a few months down the road the insurance company will figure out that they should be the secondary biller, and they will present us with a bill to recoup all those payments. Then, we will have to pass that bill on to you.
We know it is frustrating when we present you with a bill like this, but please understand that it is because we have provided services, and your insurance company has recouped those payments. We try to avoid patient balances, but this is sometimes unavoidable.
Unfortunately, this situation has been happening more and more often. We are finding that families are forgetting to tell us they have a second insurance policy, or they thought they had told us but we do not have the information on file.
2. Coordination of Benefits.
We can bill both plans, but we need you to do a few things to help the process run smoothly. You will need to do a Coordination of Benefits through both insurance companies, the primary and the secondary. This lets both plans know about each other, and each plan knows which is primary and which is secondary. And then, please make sure you let the front desk know about each policy, and provide us with both insurance cards.
Another very important item to think about is authorization. If you have Medicaid or an HMO plan, you must have authorization. We cannot render services to you until we send an authorization request to your doctor, and your doctor signs off on it and sends it to your insurance company. They will not release benefits to us until this has all happened. If we see you outside of an authorization we will not be paid, and you will not get credit for it. We may have to delay your start of therapy until we get your authorization.
Every so often there is even a PPO that requires authorization. Check your plans, and make sure you know what they require.
If your child is in ABA treatment, that almost always requires authorization.
Your Next Step
Once again: Please bring us copies of your insurance cards! If you can’t get into the office with it, you can take a picture of it and email it to us. You can get it to us any way you want, but we need to see your updated cards.