Academy of Chiropractic

Quickie Podcast 1239
Office Systems 127 OS

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"How do you know a new patient's coverage"


Dr Studin: what was the last question you just asked me?

Guest Dr: The question I had was, how do you know when a patient walks into your office if their healthcare plan is falls under Arista or not?

Dr Studin: We were talking for five minutes prior to the recording However, the real question is, and it's not just a Rissa, how do you know what the patient's coverage is walking in? So it's a simple procedure, when a patient calls, the first thing they say is, I want to make an appointment. I want to see Dr Studin and my staff says, great, that's wonderful. And, what's your name? Mary Jones. Mrs. Jones, prior to coming into the office, we'd like to save you some time in pre fill out your forms. Some people do it online, some people do it on the phone, but we'd like to pre-select your forms. Now, who doesn't want their forms Prefilled out? Who likes sitting in the doctor's office spending an hour filling that 10 pages of information. Nobody. Everybody likes to have the forms pre-filled, so they're more than happy to participate in this exercise. Name, address, phone number. What's your chief complaint? How acute is your pain? Do we need to get you in like immediately? 911 ? Do we have to triage you to the hospital? then what you say is, let's get some financial information so we can find out what's going on. So when you here, we could sit down and know, that'll help guide you financially to be able to cover the cost of the care. What is the name of your insurance company? What is your insurance policy? Who's the insured? Do you have a phone number for them? If it's an accident, do you have a claim number? That's all you need. Now after you hang up, your insurance staff sits on the phone and calls the insurance company and say, you find out if the policy is active for that person? Is there a deductible? What percentage is covered? Do you need prior authorizations? Is this an Arista plan and what does it cover? And then we'll have to determine what are your guarantees to get paid. Now, if it's a bad plan that you have a relationship with, you might want to file a UCC lien against the real property for that patient coming in to get care. Because they've got a bad insurance. Their benefits might be exhausted. This way you have full control over your business. Now, large institutions, like certain hospitals, a large medical groups are automated and being tied into the insurance carrier, and they'll be able to get right real time what the benefits are without having to call. But most offices and people that, like yourself or doctors that I deal with aren't big enough to have those resources cause this expensive to set those things up. So unless you call and qualify, you're treating in blindly, which is also why a lot of doctors are going hospital base because it's a primary care level part of the reason if they can't compete against the large institutions who have all of this information and the more information you have, the more money you'll make, you'll be able to stay in business. So this way you can make a determination prior to the patient coming in and if there's no benefits and no coverage, you get to call the patient and say, Mrs. Jones, you have an appointment for tomorrow at two o'clock. But I just want to let you know that your benefits are exhausted. So now you have a decision to make. You'll either work on leads if there's a lawyer, if it's a PI case, or you could say, you're going to have to pay cash out of your pocket. Are you prepared to pay $150 or $250 to $350 for the first visit? And then the patient has to make a decision because too often, doctors balanced bills after they render the service and that's a much lower percentage of getting paid this way you have ironclad control of your time. Did I answer your question?

Guest Dr: Yeah, the least. So the, when the staff member here calls to verify their insurance eligibility, one of the questions they can ask is this an Arista based plan or Rissa Carter plan?

Dr Studin: Oh, absolutely. Are you covered under the state insurance law or the federal Arista law? If you're on the managed care side, remember there are state approved policies and then there's federal and if there are self-insurance, So you've got to determine if it is self-insured or is it governed under state policy?

Guest Dr: Do Arista plans have to be self insured.

Dr Studin: Well, a lot of Arista plans are usually the self-insured policies. Usually.

Guest Dr: it doesn't have to be.

Dr Studin: I don't believe so. I'm not sure. I can't directly answer that question with 100% certainty. But a lot of insurers want to stay away from state rules because if you're a state govern health insurance, you have to have a certain amount of in reserve and that changes state by state. And that changes every time you gain or lose a member of how much you have to have in reserves. And different States have different rules for rules.

Guest Dr: It was explained to me this way if, if the patient walk the door, I'm trying to determine if they have an arista based plan or Rissa covered plan. You asked them two questions. First question you asked them is do you get your health insurance through your employer? And if the answer's yes, then you ask the second question, is your employer a religious organization or the government? And if the answer's no to that…

Dr Studin: what kind of organization?

Guest Dr: a religious based organization or a or the government.

Dr Studin: Why would you ask that question?

Guest Dr: Because that's how you determine if it's under Arista cause it doesn't necessarily have to be.

Dr Studin: most patients don't and won't know that, what you want to do is call the insurance company and say, are you covered under state law or Arista? That's part of the question. Now you'll know directly. One the patients won't know. And two, I think that's very discriminatory. So remember perception drives reality.

Guest Dr: We'll just ask when we call in for the eligibility.

Dr Studin: just ask the carrier, are you covered under the state of New York or under Arista and this is on the managed care side. It's more for personal injury. 

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