Insurance

[curtains1]

Does insurance, and billing drive anyone crazy?
Over the years I have encountered companies that don't allow direct billing. Only to hear the customer angrily say "THE DENTIST DOES IT!"
People don't seem to understand that I don't have a magic wand that allows me to know all their information, and be able to direct bill for them even when they have no information regarding their insurance on them.
"I don't have my card on me or info, but you should be able to bill"
I have encountered companies that send cheques to the customer by mistake rather than the provider. I have been warned by companies not to release the product until we have payment because some people will go from office to office ordering more than one pair of glasses/contacts, demanding they get them right away. One or more office will end up not getting paid even though they have called to ensure the person has coverage, because the bill is being submitted by mail, or requires time to be processed.

I have also had problems when you put a person's insurance through and they aren't covered, or they have different coverage than they thought they had. There are so many different plans, It is impossible to know why someone has one amount while someone else has a different amount. Some people think they have total coverage, when they have a percentage up to a certain amount. DON'T SHOOT THE MESSENGER!

Does this drive anyone else crazy?

[HindSight2020]

Does insurance, and billing drive anyone crazy?
Over the years I have encountered companies that don't allow direct billing. Only to hear the customer angrily say "THE DENTIST DOES IT!"
People don't seem to understand that I don't have a magic wand that allows me to know all their information, and be able to direct bill for them even when they have no information regarding their insurance on them.
"I don't have my card on me or info, but you should be able to bill"
I have encountered companies that send cheques to the customer by mistake rather than the provider. I have been warned by companies not to release the product until we have payment because some people will go from office to office ordering more than one pair of glasses/contacts, demanding they get them right away. One or more office will end up not getting paid even though they have called to ensure the person has coverage, because the bill is being submitted by mail, or requires time to be processed.

I have also had problems when you put a person's insurance through and they aren't covered, or they have different coverage than they thought they had. There are so many different plans, It is impossible to know why someone has one amount while someone else has a different amount. Some people think they have total coverage, when they have a percentage up to a certain amount. DON'T SHOOT THE MESSENGER!

Does this drive anyone else crazy?

Welcome to the world of optical service! You're not alone; in fact this is quite common in most offices. Although it is up to the patient to know when/what they are eligible for, it is good ole fashioned customer service that will diffuse any potential issues that may arise. Patients are usually misinformed, so help them through the process.

A great tool to have in house is an online portal such as Telus Health which has access to most insurance carriers. You can easily check their eligibility while they browse or are in the exam room. Probing questions early on in the visit will vastly improve the customer experience and ensure you get paid promptly!

If all else fails, pick up the phone and call the insurance provider while the patient is there. Again, it's great service when you go the extra mile! And besides, on many occasions, they may have more coverage than they thought which translates into upgrades and/or multiple pairs!

[becc971]

i've spent more time this week cursing out VSP than anything else ;)

[edKENdance]

Here's a standard scenario

client picks out a 500 dollar pair of frames and wants to use their benefits and wants me to bill for them
me: do you know how much coverage you're eligible for?
client:it's a pretty good plan. They'll pay 80%
me:calls insurance company to confirm benefits and eligibility and finds out that they're covered for 80% up to a maximum of 150.00
client:well, I'm going to have to think about it
me:it was a pleasure teaching you how your insurance plan works.

[HindSight2020]

Here's a standard scenario

client picks out a 500 dollar pair of frames and wants to use their benefits and wants me to bill for them
me: do you know how much coverage you're eligible for?
client:it's a pretty good plan. They'll pay 80%
me:calls insurance company to confirm benefits and eligibility and finds out that they're covered for 80% up to a maximum of 150.00
client:well, I'm going to have to think about it
me:it was a pleasure teaching you how your insurance plan works.

Hence why the responsibility of validating the plan coverage/eligibility falls upon the ECP right after they arrive, not after they've picked out something.

If not, the results are three-fold...you don't get paid, you only receive partial payment or they leave disgruntled without purchasing and tell all of their friends/relatives about their experience while your reputation bears the shiner.

[edKENdance]

Hence why the responsibility of validating the plan coverage/eligibility falls upon the ECP right after they arrive, not after they've picked out something.

If not, the results are three-fold...you don't get paid, you only receive partial payment or they leave disgruntled without purchasing and tell all of their friends/relatives about their experience while your reputation bears the shiner.

Have you ever worked in a retail floor environment or waited on hold with an insurance company before? Your idea does not work in that reality.

[HindSight2020]

Have you ever worked in a retail floor environment or waited on hold with an insurance company before? Your idea does not work in that reality.

Absolutely I have. Patience is a virtue. I never said it was quick, just necessary.

The use of a web based application is the best method when available.

[ex-optician]

Accepting 3rd party billing is a business decision . It depends on your location, clientele and competition. You may have no choice when it comes to Veteran Affairs, First Nations and MCSS but there is a choice on other plans. Having account receivables is time consuming. You can have over due accounts, partial payment and bad debts. All these are costs that should be added to your pricing. The nicest environment is to limit your 3rd party billing and when the customer has concerns you need an answer. "This is business decision that helps us keep costs down for all our customers" It will be the rare person who walks. Clients like this probably wouldn't have turned out to be a loyal customer if that is how they base their purchasing decision. The same logic applies when asking for a deposit before taking an order.

[curtains1]

EdKendance hit the nail on the head. Quite a few people expect you to educate them about their plan.
The thing is, insurance companies can give you the wrong info. Sometimes not give you any info, and will only talk to the patient.
Some people have more than one plan which can complicate things.
As for the web based application, not all of them work well.

[haliopt]

Just found out that for First Nations the client can submit. And get paid directly. I wonder if it is the same for veterans?

[curtains1]

not sure

[edKENdance]

I would think it is the same for veterans. I would however, bill for them though. Especially if they come in alone.

We maybe did 4 or 5 VA claims a year. Those codes are a living hell. I have no idea how anybody is supposed to be able to do that by themselves.