Patients who recently purchased insurance through an exchange may arrive at your office without proof of insurance coverage. When open enrollment began on October 1, insurance companies experienced multiple problems that prevented them from being able to register new policies into their systems. Some companies received incomplete or incorrect information from the insurance marketplaces. Other companies have been overwhelmed with the number of applications they received and have been unable to process them timely. This delay in providing proof of coverage has many consumers worrying if they really have insurance and wondering what to do next. But it also creates problems at the receptionist desk in many medical practices.
Contact the Company
The first thing you should do is contact the health plan insurance company to verify that a policy is in effect. But don’t assume that the information they offer is accurate. Ask the patient’s carrier for proof of coverage, (a fax or email) acknowledging the policy. Ask for an insurance card image copy or identification numbers. Take detailed notes of the conversation, including the date and time that the conversation took place, and the full name of the representative. Hold on to copies of any written communication you received from your insurance company such as emails or letters as you may need these materials later. These calls are recorded and time stamped at almost every insurer in the world.
Verify that the patient paid their first premium on time. Some insurers have permitted late payments for coverage that is retroactively effective to January 1. Find out the insurer’s deadline and keep any records that can serve as proof of payment. If coverage has lapsed, and the patient cannot afford to pay, if the bill is substantial and the deductible has been satisfied, consider paying the premium to force the payment to release. You can deal with IOUs downline. If a patient has not yet purchased coverage, consider having a team member in your practice set up with a private desk and service area to help the patient buy coverage from the state’s marketplace on the spot and then print out any paperwork or confirmations that are received during the enrollment process.
At worst case scenario, the patient may be required to pay for expenses out of pocket and submit for reimbursement to the extent that the service or medication is covered under the policy. You might also be able to work with the patient to delay payment for 30-45 days with a post-dated check or credit card impression on file, or set up a payment plan until you can verify that the patient is insured.
Your State Insurance Department Can Help
State Insurance Departments are not there to help the provider. They are in place to be the insured’s advocate. If your patient is having difficulty obtaining proof of coverage from their insurance company, reach out to the state insurance department for assistance. But first, obtain a letter designating your practice as an “Authorized Representative” to act as the patient’s ombudsman. Otherwise, the DOI won’t be able to talk with you or take action on the patient’s behalf.
You can find your department’s contact information online or in the telephone book.
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