Insurance, claims, prior authorization, precertification, deductibles….the list of healthcare terms goes on and on (and on). Needless to say, it’s complicated, and confusing, and there’s a lot of fine print that’s easy to miss.
We caught up with Local Infusion Reimbursement Manager Chuck Bucy to get answers to some of the most common billing questions.
- What can I do if my insurance plan denies my claim?
If you receive a notice from your insurance company that a claim has been denied for one of your visits with Local Infusion, don’t hesitate to reach out to our Billing Team directly at (844) 614-2354 to let us know.
Chances are we too have been notified of the denial and are already working with your insurance company to resolve any issues, but we always encourage patients to communicate any concerning information they receive from their insurance company just in case.
- Why do insurance companies require prior authorization?
Most insurance companies maintain a list of services and treatments that they indicate require a ‘Prior Authorization’ or ‘Precertification’ to be obtained before you receive them. This is so that the insurance company can confirm that we are providing you these services under their specific requirements and medical policies.
These requirements do vary between insurance companies, and can be updated and changed frequently.
Before you begin your treatment at Local Infusion, our staff will be contacting your insurance company to verify the authorization requirements for your specific treatment and submitting the prior authorization if necessary. We also will be communicating with your referring doctor to make sure we have all of the most up-to-date clinical information to strengthen the chances of a quick authorization turnaround.
READ MORE:
Prior Authorization: What It Is & How Long It Takes
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- What happens if prior authorization is denied?
If your prior authorization is denied, we will work closely with your provider’s office to leverage their input on whether or not the denial can be overturned or appealed further based on the information from the insurance company.
If not, we will discuss further with your provider to determine next steps.
- How do deductibles work?
Depending on your insurance policy, your insurance company may specify that there is a certain amount that you will need to meet before services are covered — that’s the deductible.
In other words, it’s the amount of money that you will need to spend on healthcare costs yourself before your insurance company begins to pay for services. The deductible amount will vary from plan-to-plan and may change when your policy renews.
Because policies can run on either a calendar year (January 1 to December 31) or a contract year (specific dates indicated by your insurance company), this deductible amount will reset when the policy renews.
Be sure to verify your current benefits with your insurance company, or reach out to us at the billing team and we can assist in getting you the most up to date information on your deductible.
- My bill is higher than expected. Who can I call to help me understand why?
Our team verifies your insurance benefits before your services start to provide you with the most accurate treatment estimate possible. Because your bill is dependent on how your insurance company processes your claims, there could be some discrepancy between our estimate and your final bill. We encourage you to give our billing team a call at (844) 614-2354 if you have any questions — we’d be happy to review your bill in detail and provide any clarity you may need.
- What’s the difference between pharmacy benefit & medical benefit? How does that affect my out-of-pocket costs?
Most insurance policies will cover treatment drugs that your provider prescribes under either your “Medical Benefit” or “Pharmacy Benefit” (depending on their coverage policies and guidelines).
When a drug is indicated as covered under your Medical Benefit, it will typically mean that the drug itself and the service cost for administering it at Local Infusion are covered under the same benefits that your insurance would cover things like doctor’s visits and hospital procedures.
When a drug is indicated as covered under your Pharmacy Benefit, it may mean that your drug will have to be specially ordered through your insurance company’s recommended pharmacy. These drugs will be covered under the same benefits that cover prescription drugs that you’d pick up at a pharmacy.
Because every insurance plan is different, with different levels of coverage within both Medical and Pharmacy Benefits, it can sometimes be difficult to determine an estimate for your out-of-pocket costs. We can help! Please don’t hesitate to reach out to our team to discuss any cost concerns or questions you may have relating to how your treatment will be covered.
READ MORE: For Reimbursement Manager Chuck Bucy, “Financial Transparency” Is More Than A Buzzword
Local Infusion Editorial : Aug 20, 2024 9:00:07 AM
