Cover your benefit quote! Why you need to have a disclaimer when verifying insurance benefits.

FACT: Successful billing depends on successful eligibility verification.

While it may seem obvious that clients make sure that they are providing up to date and correct information about themselves, when it comes to checking their eligibility you also have a responsibility to let them know that there may be a different outcome.

PLUS you want to make sure that you are protecting yourself from any issues down the road if the information that comes back on the EOB differs from what you originally thought when you verified their benefits.

I don’t know about you, but I loathe having to tell a client who we originally told they have a $20 copay that they actually have a deductible and now have a much higher fee. I really really really hate writing those emails to clients, but sometimes, it’s unavoidable.

By having a disclaimer that you use in your conversations or emails with clients you ensure that you have done due diligence and made the patient aware that their fees and benefits could change and you will not know if your quote is totally accurate until the claim is processed. This can help minimise the impact of that dreaded ‘you have a balance’ email if your original quote differs from the insurance company’s explanation of benefits.

You want to make sure you mention:

1. That the benefit check is a quote as of today. Claims can get proceed at any time and they might somehow meet their deductible etc. from the time you check their benefits to their appointment.

2. The benefit check is an estimate of their benefits and not a guarantee of coverage. Just like the insurance reps tell us when we call!

3. They can always call and verify their benefits themselves. I always encourage clients (or make it known--some don’t even know!) that they too can verify their own benefits by calling the number on the back of their insurance card. Who knew?! Haha! This is especially helpful if clients flat out disagree with your quote--’cool, please call your insurance company and let me know what you find out.’ Put it on them if they disagree with the benefit check you did for them as a courtesy.

Not sure how to word your disclaimer? Here’s my disclaimer that I put at the bottom of every benefit check email I send to my clients:

Benefit Check Disclaimer: While we try to be as accurate as possible when verifying benefits, your fees may change depending on your eligibility and benefits during the date of your sessions. This is an estimate as of today, and we won't know your exact fee until we bill your insurance and get your explanation of benefits back from your insurance company. You are also encouraged to call the number on the back of your insurance card and ask your member representative about your 'mental health, outpatient, office visit' benefits. Please let me know if you have any questions about your benefits.

If you like this script, there are many more in my Ins and Outs of Insurance Verification E-Book. It's packed with scripts on how to word benefit quotes to clients, keep benefit information organized and more.

PURCHASE THE E-BOOK HERE