The solution is to have a parent call immediately to the 3rd party payer. The payer will not correct it on the doctor’s office’s call – they don’t want to hear it from those who will be sending a claim for payment. They want the insured on the line. While they have the insured on the line, they may ask other questions, which will head off future problems.
State managed care organizations (MCOs) known as KanCare that work through the Medicaid program are supposed to get all the information uploaded to their systems nightly. All the names, dates of birth, and policy numbers are supposed to flow through. Unfortunately, the real world is a bit messier than the ideal. Somehow, the information may not be the same, and the already small Medicaid payments are loaded with administrative hassles to get these things corrected. Again, the parent has to call, but this time it is not one call to the payer, it is one to KMAP and one to the MCO.
Of course, all of these things can be checked on the websites of the insurance payers, but that is a lot of work, and if the schedule is full (as one hopes it would be), getting all those eligibilities checked is a mountainous task. There is a multiplicity of websites, all with their own logins and passwords. To say it is daunting is no exaggeration.
A pointer: Any call to the insurance payer should be accompanied by a request for a reference number and a name of the person you are talking to – otherwise, no record of the call is made. This doesn’t mean they will take care of it, but it does mean someone is on the record as saying they will.
The other front desk function that is becoming more important as insurances increase the copays is to collect the copay for insurance at the time of each visit. We are required by contract to collect the copays, because 3rd party payers use this a disincentive to visit the doctor. They want to be sure the parent/patient has a serious enough need they are willing part with money to be seen.
Further, as 3rd party payers get more savvy in this new insurance environment, more of them are cost shifting to insureds in the form of co-insurance. Co-insurance is that part of the bill that is shared between the insurance and the patient on, for example, an 80% – 20% split. But some policies have 70/30, and those bills must also be collected after the patient is seen, the claim sent, the claim paid partially by the insurance, the rest to be billed to the patient.
Also, as deductibles rise, patients have more that must be paid before insurance kicks in. Of course, patients get the advantage of the insurance company’s “negotiation” with a provider who has “agreed” to take a lower amount than the billed amount, but that still feels quite large to patients, and getting paid is sometimes difficult.
In summary, our front desks can truly make or break us one patient at time.
The Progress in Pediatrics Spring 2023 CME Meeting will be