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Question for Doctors/Dentists/Medical Office Managers
Posted on 11/2/22 at 8:43 am
Posted on 11/2/22 at 8:43 am
When a new patient calls to schedule an appointment, and you take their insurance information:
1) does the office manager know if your office is in or out of the insurance network that the patient has?
2) does the office manager check in/out of network status of the patients insurance?
3) do you tell the patient on the front end that they are trying to schedule an out of network appointment?
1) does the office manager know if your office is in or out of the insurance network that the patient has?
2) does the office manager check in/out of network status of the patients insurance?
3) do you tell the patient on the front end that they are trying to schedule an out of network appointment?
This post was edited on 11/2/22 at 8:44 am
12
Posted on 11/2/22 at 8:45 am to MadisonvilleTiger24
I seriously doubt doctors are scheduling patients. Most offices will tell you it's out of network. It's ultimately your responsibility though.
Posted on 11/2/22 at 8:46 am to MadisonvilleTiger24
Unless the Office Manager was directly involved in the answers to your specific questions, that task is the responsibility of a subordinate staff member within the office and not the manager per se. Of course, this applies to offices where its more than just a Doctor and a Receptionist/MA/Manager (2 people on site).
Posted on 11/2/22 at 8:50 am to MadisonvilleTiger24
When I called to make my 1st PT appt they took my info & called back a few minutes later to let me know it would be out of network & how much I’d owe per visit
Posted on 11/2/22 at 8:51 am to MadisonvilleTiger24
First, this is usually done by front desk staff or a referrals clerk, not the office manager. With that in mind that individual would be the following:
1) Yes, generally at the time of making the appointment depending on the situation. If you’re self-referring, likely yes.
If your appointment is being made between offices, say your PCP office directly to a specialty or surgical office the PCP office generally does your prior authorization and finds this out.
2) sort of answered this with 1, but the staff member would check your eligibility prior to your arrival to appointment in either scenario above.
3) yes, if they’ve checked the eligibility. Again, who does this would depend on the scenario in 1.
That said, depending on the EMR the practice is on this has varying degrees of difficulty and/or success.
1) Yes, generally at the time of making the appointment depending on the situation. If you’re self-referring, likely yes.
If your appointment is being made between offices, say your PCP office directly to a specialty or surgical office the PCP office generally does your prior authorization and finds this out.
2) sort of answered this with 1, but the staff member would check your eligibility prior to your arrival to appointment in either scenario above.
3) yes, if they’ve checked the eligibility. Again, who does this would depend on the scenario in 1.
That said, depending on the EMR the practice is on this has varying degrees of difficulty and/or success.
Posted on 11/2/22 at 8:53 am to LEASTBAY
quote:
It's ultimately your responsibility though.
If I wouldn’t have experienced this twice I’d say you’re correct. The two times we’ve had services provided by out of network drs, we got called with apologies from the office and refunds for the services. Once my wife showed up for surgery before someone realized they were out of network. The pre-op didn’t catch it and they refunded those bills.
Posted on 11/2/22 at 9:02 am to MadisonvilleTiger24
I usually ask them myself
Posted on 11/2/22 at 9:07 am to MadisonvilleTiger24
1- usually offices know what networks they belong to and what plans they accept. There are often some questions that arise for maybe less popular plans but they’ve for a good idea
2- Usually no. Some/most offices have someone who does check eligibility prior to an appt but it’s usually not the office manager. Patients have the ultimate responsibility to make sure they know their costs with seeing someone in network vs out of network. In those cases where the patient has no out of network benefit and cannot be balanced billed for out of network charges, the responsibility then shifts back to the provider
3- Most usually do.
2- Usually no. Some/most offices have someone who does check eligibility prior to an appt but it’s usually not the office manager. Patients have the ultimate responsibility to make sure they know their costs with seeing someone in network vs out of network. In those cases where the patient has no out of network benefit and cannot be balanced billed for out of network charges, the responsibility then shifts back to the provider
3- Most usually do.
Posted on 11/2/22 at 9:08 am to MadisonvilleTiger24
Many make the mistake of simply asking “ Do you take my insurance ABC”. Of course they will take it but it’s your responsibility to ask and double check if they are in network or not.
Posted on 11/2/22 at 9:15 am to MadisonvilleTiger24
Yeah at least the intent is there.
We verify eligibility so that we can determine co pays for day of visit.
However couple of issues:
Staffing turnover. If you are at office that dealing with a fair bit of turnover then new staff members may not be aware of all of the insurance checks or the nuances in plans.
Which brings the second point, there more nuance in insurance plans than you would think.
For instance an office my take bcbs, bcbs federal, but a newer plan off the ombaracare exchange may be bcbs pathway and the office does not accept that insurance. Patients may be inclined to call in and say that have BCBS and of course we take it but in reality the office doesn't or a new staff member may not realize the difference either.
Ultimately your best bet is to verify in networks providers yourself with your plan and not rely on the doctor office to get it done correctly
We verify eligibility so that we can determine co pays for day of visit.
However couple of issues:
Staffing turnover. If you are at office that dealing with a fair bit of turnover then new staff members may not be aware of all of the insurance checks or the nuances in plans.
Which brings the second point, there more nuance in insurance plans than you would think.
For instance an office my take bcbs, bcbs federal, but a newer plan off the ombaracare exchange may be bcbs pathway and the office does not accept that insurance. Patients may be inclined to call in and say that have BCBS and of course we take it but in reality the office doesn't or a new staff member may not realize the difference either.
Ultimately your best bet is to verify in networks providers yourself with your plan and not rely on the doctor office to get it done correctly
Posted on 11/2/22 at 9:39 am to MadisonvilleTiger24
Having just got back from the dermatologist office following an annual checkup, my question is when are they going to get back to normal and not require masks?
I don’t want to wear masks anymore. Even my dentist doesn’t require it. I’ll see in a couple of months if my PCP office requires it. I’m not hopeful there.
I don’t want to wear masks anymore. Even my dentist doesn’t require it. I’ll see in a couple of months if my PCP office requires it. I’m not hopeful there.
Posted on 11/2/22 at 9:47 am to Deplorableinohio
Find another dermatologist that doesn’t require them and doesn’t make you come back for unnecessary follow up visits from an acute issue.
This post was edited on 11/2/22 at 10:04 am
Posted on 11/2/22 at 10:15 am to MadisonvilleTiger24
Sorry, by office manager I meant front desk/admin. I’ve never changed providers before so I wasn’t aware I had to look up in/out of network. I called the front desk person, gave all of my insurance info. Appointment happened and come to find out it’s out of network. Was just trying to understand the process and if the doctor/dentist office checks on that when they check insurance (which the office said they called and it was 100% covered). Apparently my procedure was 100% covered but not for out of network providers
Posted on 11/2/22 at 10:16 am to MadisonvilleTiger24
quote:
Apparently my procedure was 100% covered but not for out of network providers
Was this a new provider for you or did their contract status with your insurance change?
Posted on 11/2/22 at 10:19 am to LSUfan4444
New provider for me. My old provider retired so I self referred myself to this new one based upon a recommendation. It’s a dentist office BTW.
Posted on 11/2/22 at 10:50 am to MadisonvilleTiger24
It's ultimately on the patient to determine whether or not the provider is in/out of network, but some offices will let you know without asking. Before making an appointment with a new provider you should always verify that they are in network.
I actually received notice from my insurance company recently letting me know that my dentist is no longer in network.
I actually received notice from my insurance company recently letting me know that my dentist is no longer in network.
Posted on 11/2/22 at 11:45 am to MadisonvilleTiger24
quote:
1) does the office manager know if your office is in or out of the insurance network that the patient has?
They probably have to run it. Even with the same carrier some plans are in and some are out, or one doc is in and another is out. Then they have out of network benefits, and specific procedure codes that are PCP only. It's a complete Charlie Foxtrot.
Since smartphones are ubiquitous the best thing would be to give patients an app where they can key in the NPI and the CPT codes.
Posted on 11/2/22 at 11:47 am to MadisonvilleTiger24
quote:
I called the front desk person, gave all of my insurance info. Appointment happened and come to find out it’s out of network. Was just trying to understand the process and if the doctor/dentist office checks on that when they check insurance (which the office said they called and it was 100% covered). Apparently my procedure was 100% covered but not for out of network providers
Probably talked to a rep at the insurance company who told them wrong.
Should just have fixed prices and the insurance company reimburses the patient (or per the patient's instructions reimburses the provider).
Posted on 11/2/22 at 11:57 am to MadisonvilleTiger24
quote:
1) does the office manager know if your office is in or out of the insurance network that the patient has?
We use a program called Availity to confirm coverage/copay.
quote:
2) does the office manager check in/out of network status of the patients insurance?
Yes. If we’re out of network, it’s private pay.
quote:
3) do you tell the patient on the front end that they are trying to schedule an out of network appointment?
Before the appointment. We may have to call back if we can’t verify immediately.
Posted on 11/2/22 at 12:02 pm to MadisonvilleTiger24
quote:
My old provider retired so I self referred myself to this new one based upon a recommendation. It’s a dentist office BTW.
Yeah, if you have out of network benefits with increased cost sharing on your part you should always check to make sure ALL services are in network (labs, diagnostics, office visits, etc.)
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