Phlebology is somewhat unique in the variety of physicians with very different American Board of Medical Specialties (ABMS) certifications. Sometimes that variety presents a challenge when benefits are communicated by the payer to the coworker at the practice. The computer system that the payer representative is looking at likely compares benefits against your primary ABMS board certification.
An example might be an Internal Medicine specialist who also has completed the additional training for their RPVI and ABVLM certifications. As far as United is concerned, this physician is still an Internal Medicine (IM) physician. When benefits are requested on a patient, the benefits quoted will also be based on ‘standard’ treatments being provided by an IM physician. Please note that other specialties can likewise have similar mis-quotes.
One frequent mistaken benefit quote might be that only the patient’s copay will apply for any services performed in the office. Then, once the claim processes, low and behold the patient owes their full deductible and a twenty percent coinsurance. The patient will now be very adamant that the ‘quote’ they were given by the practice be honored.
Here are a few tips to consider as the new year begins to ring in:
- Phlebology services are almost always subject to deductible and co-insurance. Do not believe the benefit quote if the representative paints a different picture regarding the application of the patient’s deductible and such.
- Over-quoting the patient is typically better than underquoting. It is bad for your public relations if they ‘suddenly’ owe more than a copayment.
- An office visit cannot be billed with a surgery to change the benefits. This is improper billing. It likely will not work either regardless of what the insurance representative purports.
- You are not their Primary Care Physician. In office surgery is still surgery, not a routine treatment.
- Financial surprises are not good. Be up front about cost and develop a good counseling and payment program to help patient cover the cost of treatment.
- Collect a down payment if at all possible and refund if needed. But, remember to actually send the refund.
- It is okay if they walk away. If the patient’s deductible and coinsurance was pretty high, you were getting ready to give free care AND still incur the expense of providing the care.
We know point number seven is a difficult one to swallow for some practices. If you really do a cost/benefit analysis you will see that sometimes it truly is better to let someone refuse treatment due to financial issues.
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