Happy New Years to all! Let's all have a happy & prosperous year. Part of making sure that the year starts off in the right direction is to make sure you know your patients' benefits. Remember, benefits reset at the beginning of each calendar year, so everyone starts at square one with a deductible to meet. It's important to know the details so you can A) make sure you are collecting the maximum allowable amount, and B) communicate with your patients about their responsibility until their insurance kicks in.
First, let's start with the basics: what is a deductible? According to Healthcare.gov, a deductible is "an amount you pay for covered health services before your insurance plan starts to pay." Each patient has a different deductible that is determined based on their plan type. Once the deductible is satisfied, meaning the patient has paid the deductible amount, the insurance portion kicks in. This insurance payment to your practice will either be in the form of co-insurance or co-payment, and it's important to know what your patient has.
Almost every insurance plan has a deductible, and understanding the math is a key to success. As an example, let's say your patient has a $1000 deductible, and 20% co-insurance. The allowed rate for the service you perform is $100. In this scenario, it would take 10 sessions for your patient's deductible to be satisfied, and on the 11th session the 20% co-insurance kicks in. For our example, the patient would owe $20 starting on the 11th session. The deductible could be met quicker if the patient is seeing other in-network healthcare providers and uses their insurance.
If your patient has Medicare, there is a deductible also. That deductible is $183. Sometimes, the patient will have a supplemental policy that will pay for the Medicare deductible. In other cases, the supplemental policy will have its own deductible to meet.
What should you do? Simple. Check the benefits and create a plan to discuss with your patients. For your patients who have commercial insurance, they will be responsible for the full amount "allowed" for the service you perform. It is safe to go off of last year's rates to determine how much will be owed per commercial plan, unless you received a letter or some type of correspondence indicating the rate has changed.
At GreenpointMed, we are offering customized reports for your practice. This report will go into great detail around the patient insurance details for 2018: deductible, patient responsibilities, maximum out-of-pocket, etc.. This customized report is available to any healthcare provider, practice or group and will deliver great transparency into your insurance landscape in 2018. We are also here to explain the trickier details and help you create a plan, so contact any member of our team to find out more details.