BACK TO BASICS – INSURANCE CARDS

We have received a number of calls regarding confusion on policies, plans, and products put out by the various payers. The confusion stems, in part, to the large number of plans that are being developed by the various payers. It seems like every large hospital system, commercial payer, and Medicaid replacement payers are rolling out new products in an attempt to somehow save money. Noted below are a few thoughts.

 

Review the Card Thoroughly.  If it says Advantage or has a Medicare Rx stamp anywhere on the card, it is NOT a commercial plan. Advantage is the key word meaning Medicare Replacement. If the patient presents with a Medicare card and a ‘supplemental’ card which has the word Advantage on it. They no longer have Medicare. They have a replacement plan.

 

Review the ‘Product’ on the Card.  The card may say Cigna. You may be contracted with Cigna. You may not be contracted with this Cigna plan even if you had an ‘all products’ contract originally. Many of the commercial plans have come out with very niche products which require an entirely separate contract. Unfortunately, you frequently cannot join the plan as that payer wants a very skinny network of a handful of providers.

 

Loading into Your System.  Be sure to review what address is noted on the back of the card (typically). Some plans really do not care if you are sending all of your claims to one electronic address as they have the same electronic routing number regardless of address. Other plans do seem to care and have different electronic addresses. You may have a bit of trial and error in this process but someone needs to be in charge of correcting the issue if you receive a false denial.

 

Supplement Plans. With the new codes/products out like VenaSeal and Varithena, there seems to be some confusion regarding supplemental plans. You do not have to authorize services with a supplemental plan. If Medicare pays as primary for a service, the supplemental plan has to process the claim as well.

 

Call and Double Check Eligibility. We recommend calling for benefits and to review if authorization is required. We also double check eligibility electronically on Medicare and all the commercial payers (some small plans do not participate in this process). We recommend dong the electronic double check when you first enroll the patient and then the day before the first procedure. If they had conservative therapy for three months, it is possible insurance may have changed during that time. Your clearinghouse or your Practice Management software should have this capability. If they do not, you may want to consider a change.

 

We hope to have a short series of articles in the Back to Basics realm. The next installment will be on reading an explanation of benefits.

 

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