Insurance after the fact questions..

**Alteaon** · 05-16-2008, 07:37 PM

At our office, we've had a rash of patients present vision insurance after the fact.

Obviously, insurance affects how we do things being that some insurances require us to use specific labs and specific products. This is also just plain frustrating.

We are considering writing up a financial 'waiver' of sorts, stating that above and beyond the 'whatever the ins doesn't cover is patient responsibility', that we will be happy to submit to the insurance that the patient informs us of, and that if they find that they have vision insurance after services are rendered, they can submit it to thier insurance themselves, and we'd be happy to deal w/ thier insurance during thier next exam or whatever.

This isn't a case of the optician forgetting to get the info or to ask the pt if their insurance situation has changed, but rather people who either feel we should know through psychic powers or those who found thier vision ins information collecting dust..

What does anyone else do in this situation?

Thanks!!

**cocoisland58** · 05-17-2008, 12:09 PM

Sometimes we can figure it out and redo their billing. If we can't we happily offer to fill out any required forms and get the patient reimbursed.

**For-Life** · 05-17-2008, 12:12 PM

Are you asking the patient if they have insurance and then they reply with no?

**chip anderson** · 05-17-2008, 01:24 PM

I'm beginning to suspect that some patients do this to avoid getting the type of shoddy second class service and product thier insurance company pays for.

Chip

**rbaker** · 05-17-2008, 01:39 PM

Are you referring to health insurance such as Blue Cross - Blue Shield or Vision plans such as VSP? They are different you know, and an answer to your question will depend on whether you are dealing with "health insurance" or a "prepaid eyewear plan."

**HarryChiling** · 05-17-2008, 02:34 PM

We explain to the patient that insurance companies have negotiated their benefits for a different quality product then what we use for our standard cash pay patients, we then fill out any forms in the case of comprehensive plans or in the case of discount plans we will reimburse the patient the lowest allowed benefit for instance we will give back 20% for non covered items and apply that to the entire purchase rather than 35% off frames and near 50% off on lenses like some discount plans have set up.

Our policy is to try and convert many of our insurance customers over to cash pay if possible the difference in quality as well as the level of service for cash pay paitents in many cases had lead many of our patients to drop their vision plans or to submit it themselves.

**Alteaon** · 05-17-2008, 06:17 PM

Thank you to all who have replied. This is in reference to vision plans like VSP and Spectera.
When pt's come in, we ask them for thier medical and vision insurance cards, and make sure that we have the most up to date insurance info, asking if the insurance has changed at all, etc.

We've started toying with a form the patient will fill out, basically saying "Ok, this is the info you're giving us, you don't have any other insurance and you're aware that you're going to have to pay for whatever the insurance doesn't cover, and that if you turn up w/ insurance that you forgot you had, we'll be happy to help you submit it yourselves'. It's worded better than that, though.

We are going to start dropping some vision ins in the next year. Our dream is to not deal with any vision insurances. This is to avoid issues liek the one we're in now but also then we're able to serve our patients better in terms of quality products. I like the idea of informing the pt that we can do what thier insurance will cover/ have the insurance lab do it, but it may not be what we'd choose otherwise.

**Johns** · 05-17-2008, 11:19 PM

Originally Posted by HarryChiling

We explain to the patient that insurance companies have negotiated their benefits for a different quality product then what we use for our standard cash pay patients,

Great line!:cheers:

**orangezero** · 05-18-2008, 08:33 AM

I agree it is a good line. I'll have to start using it.

Seems like something a few short sentences added on to your HIPAA privacy form might solve. I'd keep it as short and simple as possible, and have the office staff make a point to mention each patient read it before signing. I'd even add wording like "pre-paid vision discount plan" instead of being general and calling it "insurance." Big difference.

**chip anderson** · 05-18-2008, 08:55 AM

"We'll be happy to help you fill out your forms to turn in." The bill will be
$XX.XX and I'm sure they will pay you your portion.

Chip

**orangezero** · 05-18-2008, 11:15 AM

Originally Posted by chip anderson

"We'll be happy to help you fill out your forms to turn in." The bill will be
$XX.XX and I'm sure they will pay you your portion.

Chip

I'd exchange "I'm sure" to "I hope" just to be safe.:D

I have one stupid out of network plan that denies on the first, and then on the resubmission denies because they say its a duplicate claim. Its happened on all four we've sent in to them so far. Making patients pay upfront now and deal with the risk.