Educate your patients: 5 tips for teaching about insurance
By Jessica Taylor

Share this article:  

Health insurance is every practice's nightmare. I'm sure you have millions of questions that arise when you're pulling and filing claims. Don't fret, though, you're not the only one who's confused. Most of your patients do not know about their insurance either, and it's up to you to educate them. USA Today recently reported that about 7 million Americans are estimated to start buying health insurance as part of the new law, but a new survey showed they don't understand the basics of how insurance works or is provided.


Do you teach your patients about insurance?
  • 1. Yes
  • 2. No

Being the insurance manager for a medical practice, I have heard everything from patients regarding insurance. "What's a deductible?" "What does my insurance cover?" It was my job to teach patients about their insurance plan and break it down for them. By educating your patients, you will make your life and practice a lot easier. After all, if you have a happy patient, you have a happy practice.

Don't get me wrong, insurance is a hard thing to grasp. It's constantly changing, and your patients usually renew or choose new plans each year. The importance of your insurance staff being educated on these plans will benefit your practice to a great potential.

Typically, when patients have services rendered, they don't know exactly what will and will not be covered. It's your job to let them know what exactly is going on and what their possible out-of-pocket cost will be. This, in return, will let them know up front on cost value, but will also help out in your billing department when they get those vigorous calls about a bill that a patient received.

This may seem like a lot of work for the insurance team, but you will save your practice a lot of grief by following these five key points:
  1. Before the patient comes to your practice, have his/her insurance already pulled up, so the front desk knows what the copays will be and how the insurance will be billed. If the patient is coming in for a routine visit, make sure you look up the medical insurance as well, just in case the doctor finds something that could be billed medically instead of routine. Pulling insurances ahead of time is also important for your patients who have deductibles. If your patient hasn't met his/her deductible, it's good to warn the patient that he/she will most likely be receiving a bill from your office after the visit. Also, with checking patients' insurances beforehand, you will be able to see if they are eligible for services, active members, etc.
  2. Have a cheat sheet on the patient's chart for the day so each area he/she goes to, the designated staff member will know what's going on. On the cheat sheet, have the following:
    • Patient's name
    • Date of birth
    • Address
    • Social security number
    • Insurance carrier and phone number
    • ID #
    • Group #
    • Insurance carrier phone number
    • Is authorization required?
    • Is a referral required?
    • Is there a deductible?
    • Address for claims submission
    • In network or out of network
    • What is the copay?
  3. Have your insurance team create a cheat sheet for your practice, which includes the meaning of each basic insurance term. For example: A deductible is the amount of money a person must pay before his/her insurance will pay a claim. If your entire staff knows these key terms, they will be able to answer any question that may arise from a patient.
  4. All insurances are different; make sure you know the different plans your practice accepts and what each plan needs for a patient to be seen in your office. If you're out-of-network with a plan, see if the patient's plan is eligible for out-of-network benefits. Most plans have this so the patient can see the same doctor he/she has seen in previous occurrences. Questions will always arise about insurance, if you have all necessary information ahead of time, it will save you from that lengthy phone call to the carrier. Note: most of the insurance websites now have all the information you need right on their site.
  5. It's all about educating your patients; and when you educate them, you learn, too. If your patient is aware of his/her insurance and every detail needed for your practice before checking in with your front desk staff, it will make an easier process in the billing department. There are no surprises if everyone is on the same page.
By gathering the information on the patient ahead of time, you will see a much-improved reimbursement for the services rendered not only because you had the time to pull all necessary information, but now your patient understands his/her portion as well. A happy patient means a happy practice!

Jessica Taylor is a content editor at MultiBriefs specializing in the nursing and healthcare industries.