Patient Insurance: Help Us Help You

December 16, 2016

In a world where insurance plans constantly change, it is important to remind patients that they need to understand their policies.

In a world where insurance plans change so frequently it is impossible to keep up, it is important to remind patients that they need to understand their policies. 

In our office policies, which we give to patients before they come for their first appointment, it clearly says that it is their responsibility to know if they need a referral and to make sure they have one before their visit. Yet, I don’t think a day goes by that someone shows up without one. So either the patient or my staff needs to call the referring physician to make sure they send one over. 

They should also know if they have a co-pay or not. Sure, some cards have it written on them, but others don’t. And patients somehow fail to notice when a new card comes in the mail – a card that shows they have a different co-pay now. Or worse.

Employers change the policies they offer to their employees. Sometimes, the policies are similar, but sometimes they are very different. Patients need to take a good look at what the new plan offers, what it pays for, and which of their physicians are in-network. Fairly often, we have patients who we had been seeing who show up with a new insurance, and it turns out to be one we don’t participate in, or one we are out-of-network for, which means a higher co-pay or a co-insurance. 

The kicker is that they blame us. Why didn’t we tell them? Well, it’s ‘cause we’re not psychic. When they set up their 6-month follow up visit and they have Plan A; there is no way for us to know that somewhere during that 6-month interval they will switch to Plan B. 

I tell patients that there is only one plan they need to understand – their own. We can’t attempt to understand the 60 different plans that our patients have. Every time they get a new card, every open enrollment, they need to sit down and figure out what their co-pays are, if they need referrals, and who is in-network. Unfortunately, I only have this conversation after some problem has occurred. As I said, it is in our office policy. But they probably skip reading that, just like they skip readings about their plan.