Quick Tips: New Year Benefit Checks

HAPPY 2018!

The new year brings many changes to insurance benefits such as:

• Deductibles resetting
• 2017 plans becoming inactive
• Job changes

I highly recommend verifying insurance coverage for your clients ahead of time.

• Clients are informed if their deductibles reset and they now have to pay a higher fee.
  • If they can’t afford the higher fee they sometimes cancel their appointments (brace yourself for this–it DOES happen), but better they know ahead of time and cancel rather than being blindsided by a bill later or in session. AWKWARD.
• Reduces claims issues for YOU.
  • Billing a 2017 plan that is inactive–can prevent this.
  • Unaware that you should be collecting your contracted rate due to a deductible resetting now the client owes you money and is MIA–can prevent this. 

It may be a good idea, but it can all be very overwhelming! 

Here are some tips (that I use myself) in the new year when rechecking benefits.

• I start checking on the first of the year (that would be today!)
• I DON’T check them all at once!
  • I like to check my clients’ benefits week by week based on when they are coming in for their first session of the year.
• I group them into insurance panels.
  • I checked all of my Aetna clients first (for this week) then United etc.
• I make notes in my EHR like this:
  • 1/1: Copay is $25
  • 1/1: Deductible reset to $500 with nothing met. New fee is: $XX until the deductible is met about X sessions.
• If benefits have changed I e-mail clients their new benefits.
• If the insurance information I have comes back as inactive (odds are the client’s plan changed for the new year) I e-mail to inquire about insurance changes.

Here is an example of an e-mail I wrote a client when their deductible reset:

Happy New Year! I’ve checked your benefits for 2018 and you have a $500 deductible with nothing met then a 20% co-insurance. Since I am in-network with your insurance, you will receive a discount of $XX for your first session and $XX for sessions after that. Your entire fees will go towards your deductible. Once you meet your deductible (about X sessions assuming you do not use your insurance for any other medical expenses) your fee would then be $XX. If you have HSA/FSA/HRA funds you may use those funds towards your fee. Please let me know if you have any questions.

To help with benefit checks I bookmarked all of the insurance portals that I frequently use.

Here are a few:

United (UBH plans) (linked to main page, click login to get to portal)

Aetna (NaviNet–also used for other panels depending)

Availity (I use it for BCBS of IL and Humana).

Cigna

Magellan

When possible I save the client information in the portal so I can easily re-verify their benefits and check claims.

I also make note of any EAP authorizations that have expired at the end of 2017 and make a note to call the EAP to extend or get a new auth on 1/2.

Hopefully, these tips help! Please e-mail me if you have any questions or purchase a “Pick My Brain” Session here.