Hi Lin,

"Hippo" is the Greek word for Horse...

Here is a website more about Hippotherapy...
http://www.americanequestrian.com/hippotherapy.htm

:-) Sorry for the confusion, but I do appreciate everyone's help!
Thank you!

Jaime




--- In MedicalBillers@yahoogroups.com, "Lin" <italiandoll1967@...> wrote:
>
> Ok, I understand much better, but have to ask why is it called "HIPPO"
> therapy .. does HIPPO stand for something..?
>
>
>
>
>
> Linda Walker
>
> Practice Managers Resource & Networking Community
>  <http://www.billerswebsite.com> http://www.billerswebsite.com
> A division of K&L Media, LLC
>  <http://www.klmediallc.com> http://www.klmediallc.com

Dear All,

I am Sebastian, desperately looking for job. I have 10 years
experience in US Health Care (Health care BPO/KPO) exposure and also
holding a US B1 Visa with multiple entry for 10 years.

Please help me

Sincerely
Sebastian

Contact me outside of the group. You're too far away for a permanent job, but
maybe I could help with a temp job.
Karen@...
Thanks




________________________________
From: mail2sebii <mail2sebii@...>
To: MedicalBillers@yahoogroups.com
Sent: Sunday, February 1, 2009 11:56:01 PM
Subject: [MedicalBillers] Looking for a suitable Job


Dear All,

I am Sebastian, desperately looking for job. I have 10 years
experience in US Health Care (Health care BPO/KPO) exposure and also
holding a US B1 Visa with multiple entry for 10 years.

Please help me

Sincerely
Sebastian






[Non-text portions of this message have been removed]

Hey Sebastian;

There is an Urgent Opening as Sr Manager Operations in Chennai, I would
appreciate if you could give a try.

Regards,
Joktan

" My Presence shall go with thee, and I will give thee Rest " - Exodus 33:14
Contact Details:
Joktan R Edison
Cell: 1 (201) 977 1234 
efax:1-509-695-9578
www.edisonandleesolutions.com   


--- On Mon, 2/2/09, rekha.s@... <rekha.s@...> wrote:

> From: rekha.s@... <rekha.s@...>
> Subject: Urgent opening for "Senior Manager Operations"
> To: ejoktan@...
> Date: Monday, February 2, 2009, 4:11 AM
> Dear Joktan,
> 		     Greetings from QUSCIENT TECHNOLOGY PVT LTD !!!
>
> Quscient (pronounced as Q-scient) is an IT/ITES company,
> with deep experience in process and technology solutions and
> offers transformational Business Process Outsourcing
> services to mid-market customers in the USA. Quscient has
> been named one of the Top 100 IT innovators in India for the
> year 2007 by NASSCOM.
> www.nasscom.in/100itinnovators).
>
> Currently we are looking for ''Senior Manager
> Operations ''
>
> Experience    :  8 to 12 years
>
>  Location       : Chennai
>
> Compensation : BEST IN THE INDUSRTY
>
> Education:UG - Any Graduate - Any Specialization
>                 PG - Any PG Course - Any Specialization
>
> JOB DESCRIPTION:
> Accountable for the delivery of service levels across
> multi- campaigns in the Contact Centre
> Should be a customer centric person
> Handled Contact centre processes which includes and is not
> limited to:
> Outbound Sales
> Outbound Survey programs
> Some Inbound experience
> Experience in implementing Quality control programs
> Implemented training programs and evaluation mechanisms
> Motivation and leadership of contact centre teams
> Experience in implementing MIS systems
> Experience in controlling costs, effective utilization of
> budgets and constantly working on increasing profitability
> Good understanding of Contact Centre Technology (Switch,
> Dialer, integration with client equipment and systems etc.)
> Should constantly mentor and build a vibrant team of leads
>
>
>
> DESIRED CANDIDATE PROFILE:
>
>  Any graduate with 2-4 years work-ex in outbound calling
> (international call centre experience required).
>
> Prior experience working in Business Development back
> office or sales support would be an added advantage.
>
> Experience in concept or services selling background
>
> Should have very good communication skills (written and
> spoken English should be V.Good)
>
> Should be a good conversationalist.
>
> Should be willing to work in night shifts
>
>  Should be a patient and persistent individual
>
>
>  If you fit the above criteria and if your interested
> please specify “Senior Ops Manager" in the SUBJECT
> LINE and send your Profiles to rekha.s@...
>
> Location
>
> Quscient Technologies Private Limited
> Module No. 1207, North Block D
> 12th Floor TIDEL Park
> No. 4, Rajiv Gandhi Salai
> Taramani, Chennai 600 113
> Contact Number:044- 42118120
>
> Thanks & Regards,
>
> Rekha.
>
>
>
>
>
> 	 This mail has been sent by one of the employers (Employer
> name: Quscient Technologies Pvt Ltd) accessing the services
> of monsterindia.com and not by Monster. Monster is committed
> to protecting the privacy of our users and our "Terms
> of Use" prohibits any misuse including spamming. If you
> consider the contents of the mails inappropriate or as spam,
> please forward this mail to spam@...
>
>
>
> 	 Double your chances of getting the right job by keeping
> your resume updated.
> 		 To Update Resume, please copy and paste this URL into
> the address bar of your browser
> "http://my.monsterindia.com/login.html?spl=empmailjun19".

This may be a dumb question but I am at a loss.  Our doctor billed a well
exam with the icd9 code 89.7 which is a valid code according to the online
icd9 sites but our clearinghouse rejected saying not enough digits.  When I
questioned them they said that I had to expand it according to the notes in
the icd9 book.  I have searched the book and don't see the notes.  How do I
expand the code?



Margo Tockerman

(p) (404) 270-9635

(f)  (678) 298-6214

  <http://www.apsbilling.net> www.apsbilling.net





[Non-text portions of this message have been removed]

Yeah, it's not a valid code-what is the actual diagnosis? I can try to look it
up for you...my suggestion is to always use your ICD-9 coding book (the official
one), you can't always trust these online sites...
 
Erika




--- On Mon, 2/2/09, Margo Tockerman <margo@...> wrote:

From: Margo Tockerman <margo@...>
Subject: [MedicalBillers] Expanding Codes
To: MedicalBillers@yahoogroups.com
Date: Monday, February 2, 2009, 4:05 PM






This may be a dumb question but I am at a loss. Our doctor billed a well
exam with the icd9 code 89.7 which is a valid code according to the online
icd9 sites but our clearinghouse rejected saying not enough digits. When I
questioned them they said that I had to expand it according to the notes in
the icd9 book. I have searched the book and don't see the notes. How do I
expand the code?

Margo Tockerman

(p) (404) 270-9635

(f) (678) 298-6214

<http://www.apsbilli ng.net> www.apsbilling. net

[Non-text portions of this message have been removed]


















[Non-text portions of this message have been removed]

89.7 is an ICD-9 volume 3 code which are actually procedure codes used by
facilities, not diagnosis codes. If what your doctor did was a preventive exam
and the patient has no complaints or illnesses, then you are probably looking
for something in the V70.0 - V72.9 section of ICD-9 volume 1-2 which are
the physician billing codes.
 
V70.0 is "Routine general medical exam at a health care facility", but depending
on your patient's age and circumstance you may need a more specific exam code.
If your patient is getting a physical for work, school, commercial drivers
license, medico-legal reasons, pre op etc, there are more specific codes for
those.
 
Barbara Burgess, RN, CPC, ACS-EM, PCS
Coding Compliance Nurse Specialist
University of South Alabama 

--- On Tue, 2/3/09, Erika Dennis <rikaroo0081@...> wrote:

From: Erika Dennis <rikaroo0081@...>
Subject: Re: [MedicalBillers] Expanding Codes
To: MedicalBillers@yahoogroups.com
Date: Tuesday, February 3, 2009, 7:29 AM






Yeah, it's not a valid code-what is the actual diagnosis? I can try to look it
up for you...my suggestion is to always use your ICD-9 coding book (the official
one), you can't always trust these online sites...
 
Erika

--- On Mon, 2/2/09, Margo Tockerman <margo@apsbilling. net> wrote:

From: Margo Tockerman <margo@apsbilling. net>
Subject: [MedicalBillers] Expanding Codes
To: MedicalBillers@ yahoogroups. com
Date: Monday, February 2, 2009, 4:05 PM

This may be a dumb question but I am at a loss. Our doctor billed a well
exam with the icd9 code 89.7 which is a valid code according to the online
icd9 sites but our clearinghouse rejected saying not enough digits. When I
questioned them they said that I had to expand it according to the notes in
the icd9 book. I have searched the book and don't see the notes. How do I
expand the code?

Margo Tockerman

(p) (404) 270-9635

(f) (678) 298-6214

<http://www.apsbilli ng.net> www.apsbilling. net

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]


















[Non-text portions of this message have been removed]

Thanks Barbara and Erika,

Barbara -Thanks for the information about the facilities.  I didnt
know that.  I have seen those 3 digits codes before and never knew
what they were for.

Erika- thanks for your offer.  I appreciate it.  I actually have a
book and searched it for that code and couldnt find it. I thought I
was missing something about expanding codes but per Barbara, the codes
dont even apply.

Thank your help.  I really appreciate it.

--- In MedicalBillers@yahoogroups.com, B Burgess <granbfly@...> wrote:
>
> 89.7 is an ICD-9 volume 3 code which are actually procedure codes
used by facilities, not diagnosis codes. If what your doctor did was a
preventive exam and the patient has no complaints or illnesses, then
you are probably looking for something in the V70.0 - V72.9 section of
ICD-9 volume 1-2 which are the physician billing codes.
>  
> V70.0 is "Routine general medical exam at a health care facility",
but depending on your patient's age and circumstance you may need a
more specific exam code. If your patient is getting a physical for
work, school, commercial drivers license, medico-legal reasons, pre op
etc, there are more specific codes for those.
>  
> Barbara Burgess, RN, CPC, ACS-EM, PCS
> Coding Compliance Nurse Specialist
> University of South Alabama 
>
> --- On Tue, 2/3/09, Erika Dennis <rikaroo0081@...> wrote:
>
> From: Erika Dennis <rikaroo0081@...>
> Subject: Re: [MedicalBillers] Expanding Codes
> To: MedicalBillers@yahoogroups.com
> Date: Tuesday, February 3, 2009, 7:29 AM
>
>
>
>
>
>
> Yeah, it's not a valid code-what is the actual diagnosis? I can try
to look it up for you...my suggestion is to always use your ICD-9
coding book (the official one), you can't always trust these online
sites...
>  
> Erika
>
> --- On Mon, 2/2/09, Margo Tockerman <margo@apsbilling. net> wrote:
>
> From: Margo Tockerman <margo@apsbilling. net>
> Subject: [MedicalBillers] Expanding Codes
> To: MedicalBillers@ yahoogroups. com
> Date: Monday, February 2, 2009, 4:05 PM
>
> This may be a dumb question but I am at a loss. Our doctor billed a well
> exam with the icd9 code 89.7 which is a valid code according to the
online
> icd9 sites but our clearinghouse rejected saying not enough digits.
When I
> questioned them they said that I had to expand it according to the
notes in
> the icd9 book. I have searched the book and don't see the notes. How
do I
> expand the code?
>
> Margo Tockerman
>
> (p) (404) 270-9635
>
> (f) (678) 298-6214
>
> <http://www.apsbilli ng.net> www.apsbilling. net
>
> [Non-text portions of this message have been removed]
>
> [Non-text portions of this message have been removed]
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
>
> [Non-text portions of this message have been removed]
>

I thought I posted this but it didnt seem to go through so if this is
a repeat I am sorry.

Another dumb question... I am not a coder (obviously!!) HCPCs codes
only cover medications that are injections not tablets, right?

Thanks-
Margo

Hello  :)

Does anyone have a general statement or disclaimer they use to their patients to
tell them when they ask...."What does my insurance cover" or "what are my
benefits".  The reason I'm asking is because my office has had some clients (we
are a speech therapy office so we call patients, clients) go on Yelp.com and be
very cruel to our office.  Luckily, it wasn't me that was complained about on
yelp.  The previous receptionist told people what their insurance told her.  Of
course, (as insurance companies have their disclaimer) nothing is a guarantee of
payment.

Unfortunately, certain clients insurances have said one thing and then turned
around and denied the claims.  Then the office medical biller has to contact the
client and tell them the bad news.  So then, we get in trouble from the client
and get blamed.  I've only been at my job for 7 months.  Everyday I learn
something new and how to word things.

Anyone use a disclaimer statement or your own created statement to let patients
know that checking benefits and the info you got is no guarantee of coverage or
insurance?  My director jumped all over me just for saying to a client..."Well
your insurance told me....".  My gosh...I got in so much trouble from my office
director.  So what I do now is I tell clients to call their insurance company to
get the info and I that I only check eligibility.  I would like to be confident
and not look like a deer in headlights when they ask the question.  I don't want
to say the wrong thing.

Thanks so much for your help!  :)  It's very much appreciated!

Carol  :)

When benefits are checked by calling the carrier they all contain a
disclaimer via recording or the representative will tell you either before
or after they read the benefits: "Verification of benefits is not a
guarantee of payment, payment is contingent upon policy and eligibility at
the time services are rendered".



If the office is doing the benefits and verifications there should be a form
used and you can add it to the bottom ..but technically it's not necessary
as the insurance company is the one libel for their determination. Aside
from that the patient is responsible for knowing their own policies. All you
are doing is a courtesy check for them. If the patient's are contacting
their own insurance companies then again..they will be advised of the
disclaimer. If you use a form to verify eligibility and benefits you can
make a copy and present it to the patient if you choose.



As for patient's going on a public forum or website and making comments.
this is very unprofessional, however you nor the providers should engage in
any activity/response and it would be to the providers benefit to contact
their attorney for advice on how to handle this kind of situation.





Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry







From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of Carol Roush
Sent: Saturday, February 07, 2009 12:33 PM
To: MedicalBillers@yahoogroups.com
Subject: [MedicalBillers] Suggestions on how to word what is covered by
patients insurance company



Hello :)

Does anyone have a general statement or disclaimer they use to their
patients to tell them when they ask...."What does my insurance cover" or
"what are my benefits". The reason I'm asking is because my office has had
some clients (we are a speech therapy office so we call patients, clients)
go on Yelp.com and be very cruel to our office. Luckily, it wasn't me that
was complained about on yelp. The previous receptionist told people what
their insurance told her. Of course, (as insurance companies have their
disclaimer) nothing is a guarantee of payment.

Unfortunately, certain clients insurances have said one thing and then
turned around and denied the claims. Then the office medical biller has to
contact the client and tell them the bad news. So then, we get in trouble
from the client and get blamed. I've only been at my job for 7 months.
Everyday I learn something new and how to word things.

Anyone use a disclaimer statement or your own created statement to let
patients know that checking benefits and the info you got is no guarantee of
coverage or insurance? My director jumped all over me just for saying to a
client..."Well your insurance told me....". My gosh...I got in so much
trouble from my office director. So what I do now is I tell clients to call
their insurance company to get the info and I that I only check eligibility.
I would like to be confident and not look like a deer in headlights when
they ask the question. I don't want to say the wrong thing.

Thanks so much for your help! :) It's very much appreciated!

Carol :)





__________ Information from ESET Smart Security, version of virus signature
database 3836 (20090207) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

Thanks so much for your help!  :)  We tell our clients in person and on our
office website that they are to check their benefits but they just don't.  We
have so many forms that we have the clients fill out that we are not responsible
for the actions or determination of their insurance.  No matter what - we are
yelled and screamed at by clients.  We also have been reported to the Better
Business Bureau because of the clients insurance.  I think this is completely
wrong.  Now we have a rating of C on the BBB site just because of insurance
companies denying the claims.  So even though we have great speech
therapists....we look bad because of an insurance company denying someone.  It's
really crazy and so tiring.

Thanks again  :)

Carol


--- On Sat, 2/7/09, Lin <italiandoll1967@...> wrote:

> From: Lin <italiandoll1967@...>
> Subject: RE: [MedicalBillers] Suggestions on how to word what is covered by
patients insurance company
> To: MedicalBillers@yahoogroups.com
> Date: Saturday, February 7, 2009, 5:42 PM
> When benefits are checked by calling the carrier they all
> contain a
> disclaimer via recording or the representative will tell
> you either before
> or after they read the benefits: "Verification of
> benefits is not a
> guarantee of payment, payment is contingent upon policy and
> eligibility at
> the time services are rendered".
>
>
>
> If the office is doing the benefits and verifications there
> should be a form
> used and you can add it to the bottom ..but technically
> it's not necessary
> as the insurance company is the one libel for their
> determination. Aside
> from that the patient is responsible for knowing their own
> policies. All you
> are doing is a courtesy check for them. If the
> patient's are contacting
> their own insurance companies then again..they will be
> advised of the
> disclaimer. If you use a form to verify eligibility and
> benefits you can
> make a copy and present it to the patient if you choose.
>
>
>
> As for patient's going on a public forum or website and
> making comments.
> this is very unprofessional, however you nor the providers
> should engage in
> any activity/response and it would be to the providers
> benefit to contact
> their attorney for advice on how to handle this kind of
> situation.
>
>
>
>
>
> Linda Walker
>
> Practice Managers Resource & Networking Community
>  <http://www.billerswebsite.com>
> http://www.billerswebsite.com
> A division of K&L Media, LLC
>  <http://www.klmediallc.com>
> http://www.klmediallc.com
>
> Website Design & Management for the Medical Services
> Industry
>
>
>
>
>
>
>
> From: MedicalBillers@yahoogroups.com
> [mailto:MedicalBillers@yahoogroups.com]
> On Behalf Of Carol Roush
> Sent: Saturday, February 07, 2009 12:33 PM
> To: MedicalBillers@yahoogroups.com
> Subject: [MedicalBillers] Suggestions on how to word what
> is covered by
> patients insurance company
>
>
>
> Hello :)
>
> Does anyone have a general statement or disclaimer they use
> to their
> patients to tell them when they ask...."What does my
> insurance cover" or
> "what are my benefits". The reason I'm asking
> is because my office has had
> some clients (we are a speech therapy office so we call
> patients, clients)
> go on Yelp.com and be very cruel to our office. Luckily, it
> wasn't me that
> was complained about on yelp. The previous receptionist
> told people what
> their insurance told her. Of course, (as insurance
> companies have their
> disclaimer) nothing is a guarantee of payment.
>
> Unfortunately, certain clients insurances have said one
> thing and then
> turned around and denied the claims. Then the office
> medical biller has to
> contact the client and tell them the bad news. So then, we
> get in trouble
> from the client and get blamed. I've only been at my
> job for 7 months.
> Everyday I learn something new and how to word things.
>
> Anyone use a disclaimer statement or your own created
> statement to let
> patients know that checking benefits and the info you got
> is no guarantee of
> coverage or insurance? My director jumped all over me just
> for saying to a
> client..."Well your insurance told me....". My
> gosh...I got in so much
> trouble from my office director. So what I do now is I tell
> clients to call
> their insurance company to get the info and I that I only
> check eligibility.
> I would like to be confident and not look like a deer in
> headlights when
> they ask the question. I don't want to say the wrong
> thing.
>
> Thanks so much for your help! :) It's very much
> appreciated!
>
> Carol :)
>
>
>
>
>
> __________ Information from ESET Smart Security, version of
> virus signature
> database 3836 (20090207) __________
>
> The message was checked by ESET Smart Security.
>
> http://www.eset.com
>
>
>
> [Non-text portions of this message have been removed]

Is your office verifying benefits and eligibility? Or are you cash pay and
leaving it up to the patient to submit?  This makes a difference. If you are
billing insurance it's a good practice to do the benefits/verification from
the office and giving the patient a copy will help you eliminate problems
before they happen. If you are a cash practice and not collecting at the
time of service that can cause headaches too. You should also have patient's
read and sign the financial policy of the office.

It is not uncommon a patient will get upset when they get a bill weeks or
months later and see a balance where they don't expect to see one. That can
be fixed but it requires the office to stick with ONE procedure for all
patient's. If you are going to bill insurance then you should do the
verifications, note them in the patient file and give the patient a copy.
The form should contain the date and the person you spoke with. The
disclaimer can be at the bottom and this way the patient can take up any
problems with the carrier directly.

In any office that bills insurance it is always a good policy to do the
verifications IN the office as it will be the lifeline of the revenue.

Another idea is to post the financial policy in the office at the
receptionists desk. If you are a cash practice you can put up a sign that
says "Payment in full is expected at the time of service"





Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry





From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of Carol Roush
Sent: Saturday, February 07, 2009 12:48 PM
To: MedicalBillers@yahoogroups.com
Subject: [MedicalBillers] Thanks Linda :)



Thanks so much for your help! :) We tell our clients in person and on our
office website that they are to check their benefits but they just don't. We
have so many forms that we have the clients fill out that we are not
responsible for the actions or determination of their insurance. No matter
what - we are yelled and screamed at by clients. We also have been reported
to the Better Business Bureau because of the clients insurance. I think this
is completely wrong. Now we have a rating of C on the BBB site just because
of insurance companies denying the claims. So even though we have great
speech therapists....we look bad because of an insurance company denying
someone. It's really crazy and so tiring.

Thanks again :)

Carol

--- On Sat, 2/7/09, Lin <italiandoll1967@...
<mailto:italiandoll1967%40yahoo.com> > wrote:

> From: Lin <italiandoll1967@... <mailto:italiandoll1967%40yahoo.com>
>
> Subject: RE: [MedicalBillers] Suggestions on how to word what is covered
by patients insurance company
> To: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
> Date: Saturday, February 7, 2009, 5:42 PM
> When benefits are checked by calling the carrier they all
> contain a
> disclaimer via recording or the representative will tell
> you either before
> or after they read the benefits: "Verification of
> benefits is not a
> guarantee of payment, payment is contingent upon policy and
> eligibility at
> the time services are rendered".
>
>
>
> If the office is doing the benefits and verifications there
> should be a form
> used and you can add it to the bottom ..but technically
> it's not necessary
> as the insurance company is the one libel for their
> determination. Aside
> from that the patient is responsible for knowing their own
> policies. All you
> are doing is a courtesy check for them. If the
> patient's are contacting
> their own insurance companies then again..they will be
> advised of the
> disclaimer. If you use a form to verify eligibility and
> benefits you can
> make a copy and present it to the patient if you choose.
>
>
>
> As for patient's going on a public forum or website and
> making comments.
> this is very unprofessional, however you nor the providers
> should engage in
> any activity/response and it would be to the providers
> benefit to contact
> their attorney for advice on how to handle this kind of
> situation.
>
>
>
>
>
> Linda Walker
>
> Practice Managers Resource & Networking Community
> <http://www.billerswebsite.com>
> http://www.billerswebsite.com
> A division of K&L Media, LLC
> <http://www.klmediallc.com>
> http://www.klmediallc.com
>
> Website Design & Management for the Medical Services
> Industry
>
>
>
>
>
>
>
> From: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
> [mailto:MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com> ]
> On Behalf Of Carol Roush
> Sent: Saturday, February 07, 2009 12:33 PM
> To: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
> Subject: [MedicalBillers] Suggestions on how to word what
> is covered by
> patients insurance company
>
>
>
> Hello :)
>
> Does anyone have a general statement or disclaimer they use
> to their
> patients to tell them when they ask...."What does my
> insurance cover" or
> "what are my benefits". The reason I'm asking
> is because my office has had
> some clients (we are a speech therapy office so we call
> patients, clients)
> go on Yelp.com and be very cruel to our office. Luckily, it
> wasn't me that
> was complained about on yelp. The previous receptionist
> told people what
> their insurance told her. Of course, (as insurance
> companies have their
> disclaimer) nothing is a guarantee of payment.
>
> Unfortunately, certain clients insurances have said one
> thing and then
> turned around and denied the claims. Then the office
> medical biller has to
> contact the client and tell them the bad news. So then, we
> get in trouble
> from the client and get blamed. I've only been at my
> job for 7 months.
> Everyday I learn something new and how to word things.
>
> Anyone use a disclaimer statement or your own created
> statement to let
> patients know that checking benefits and the info you got
> is no guarantee of
> coverage or insurance? My director jumped all over me just
> for saying to a
> client..."Well your insurance told me....". My
> gosh...I got in so much
> trouble from my office director. So what I do now is I tell
> clients to call
> their insurance company to get the info and I that I only
> check eligibility.
> I would like to be confident and not look like a deer in
> headlights when
> they ask the question. I don't want to say the wrong
> thing.
>
> Thanks so much for your help! :) It's very much
> appreciated!
>
> Carol :)
>
>
>
>
>
> __________ Information from ESET Smart Security, version of
> virus signature
> database 3836 (20090207) __________
>
> The message was checked by ESET Smart Security.
>
> http://www.eset.com
>
>
>
> [Non-text portions of this message have been removed]





__________ Information from ESET Smart Security, version of virus signature
database 3836 (20090207) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

I want to also add that I think it is NOT in the best interest for any
healthcare provider to be a member of the BBB. I have my own opinion about
the BBB in general which I won't go into.  To be fair, if your office is a
member of the BBB your rating is not just determined by the actual number of
complaints but how you respond to them and document to the BBB, so if your
office is not responding to the complaints AND updating the BBB when you do
that is a problem.  Also you have to keep in mind HIPAA when you respond and
this is the reason I feel healthcare providers SHOULD not get involved with
the BBB, they have a right to post responses and it's just too easy to
violate HIPAA when you are trying to resolve "public" complaints.





Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry







From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of Lin
Sent: Saturday, February 07, 2009 1:12 PM
To: MedicalBillers@yahoogroups.com
Subject: RE: [MedicalBillers] Thanks Linda :)



Is your office verifying benefits and eligibility? Or are you cash pay and
leaving it up to the patient to submit? This makes a difference. If you are
billing insurance it's a good practice to do the benefits/verification from
the office and giving the patient a copy will help you eliminate problems
before they happen. If you are a cash practice and not collecting at the
time of service that can cause headaches too. You should also have patient's
read and sign the financial policy of the office.

It is not uncommon a patient will get upset when they get a bill weeks or
months later and see a balance where they don't expect to see one. That can
be fixed but it requires the office to stick with ONE procedure for all
patient's. If you are going to bill insurance then you should do the
verifications, note them in the patient file and give the patient a copy.
The form should contain the date and the person you spoke with. The
disclaimer can be at the bottom and this way the patient can take up any
problems with the carrier directly.

In any office that bills insurance it is always a good policy to do the
verifications IN the office as it will be the lifeline of the revenue.

Another idea is to post the financial policy in the office at the
receptionists desk. If you are a cash practice you can put up a sign that
says "Payment in full is expected at the time of service"

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
<http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
[mailto:MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com> ]
On Behalf Of Carol Roush
Sent: Saturday, February 07, 2009 12:48 PM
To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>

Subject: [MedicalBillers] Thanks Linda :)

Thanks so much for your help! :) We tell our clients in person and on our
office website that they are to check their benefits but they just don't. We
have so many forms that we have the clients fill out that we are not
responsible for the actions or determination of their insurance. No matter
what - we are yelled and screamed at by clients. We also have been reported
to the Better Business Bureau because of the clients insurance. I think this
is completely wrong. Now we have a rating of C on the BBB site just because
of insurance companies denying the claims. So even though we have great
speech therapists....we look bad because of an insurance company denying
someone. It's really crazy and so tiring.

Thanks again :)

Carol

--- On Sat, 2/7/09, Lin <italiandoll1967@...
<mailto:italiandoll1967%40yahoo.com>
<mailto:italiandoll1967%40yahoo.com> > wrote:

> From: Lin <italiandoll1967@... <mailto:italiandoll1967%40yahoo.com>
<mailto:italiandoll1967%40yahoo.com>
>
> Subject: RE: [MedicalBillers] Suggestions on how to word what is covered
by patients insurance company
> To: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
> Date: Saturday, February 7, 2009, 5:42 PM
> When benefits are checked by calling the carrier they all
> contain a
> disclaimer via recording or the representative will tell
> you either before
> or after they read the benefits: "Verification of
> benefits is not a
> guarantee of payment, payment is contingent upon policy and
> eligibility at
> the time services are rendered".
>
>
>
> If the office is doing the benefits and verifications there
> should be a form
> used and you can add it to the bottom ..but technically
> it's not necessary
> as the insurance company is the one libel for their
> determination. Aside
> from that the patient is responsible for knowing their own
> policies. All you
> are doing is a courtesy check for them. If the
> patient's are contacting
> their own insurance companies then again..they will be
> advised of the
> disclaimer. If you use a form to verify eligibility and
> benefits you can
> make a copy and present it to the patient if you choose.
>
>
>
> As for patient's going on a public forum or website and
> making comments.
> this is very unprofessional, however you nor the providers
> should engage in
> any activity/response and it would be to the providers
> benefit to contact
> their attorney for advice on how to handle this kind of
> situation.
>
>
>
>
>
> Linda Walker
>
> Practice Managers Resource & Networking Community
> <http://www.billerswebsite.com>
> http://www.billerswebsite.com
> A division of K&L Media, LLC
> <http://www.klmediallc.com>
> http://www.klmediallc.com
>
> Website Design & Management for the Medical Services
> Industry
>
>
>
>
>
>
>
> From: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
> [mailto:MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com> ]
> On Behalf Of Carol Roush
> Sent: Saturday, February 07, 2009 12:33 PM
> To: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
> Subject: [MedicalBillers] Suggestions on how to word what
> is covered by
> patients insurance company
>
>
>
> Hello :)
>
> Does anyone have a general statement or disclaimer they use
> to their
> patients to tell them when they ask...."What does my
> insurance cover" or
> "what are my benefits". The reason I'm asking
> is because my office has had
> some clients (we are a speech therapy office so we call
> patients, clients)
> go on Yelp.com and be very cruel to our office. Luckily, it
> wasn't me that
> was complained about on yelp. The previous receptionist
> told people what
> their insurance told her. Of course, (as insurance
> companies have their
> disclaimer) nothing is a guarantee of payment.
>
> Unfortunately, certain clients insurances have said one
> thing and then
> turned around and denied the claims. Then the office
> medical biller has to
> contact the client and tell them the bad news. So then, we
> get in trouble
> from the client and get blamed. I've only been at my
> job for 7 months.
> Everyday I learn something new and how to word things.
>
> Anyone use a disclaimer statement or your own created
> statement to let
> patients know that checking benefits and the info you got
> is no guarantee of
> coverage or insurance? My director jumped all over me just
> for saying to a
> client..."Well your insurance told me....". My
> gosh...I got in so much
> trouble from my office director. So what I do now is I tell
> clients to call
> their insurance company to get the info and I that I only
> check eligibility.
> I would like to be confident and not look like a deer in
> headlights when
> they ask the question. I don't want to say the wrong
> thing.
>
> Thanks so much for your help! :) It's very much
> appreciated!
>
> Carol :)
>
>
>
>
>
> __________ Information from ESET Smart Security, version of
> virus signature
> database 3836 (20090207) __________
>
> The message was checked by ESET Smart Security.
>
> http://www.eset.com
>
>
>
> [Non-text portions of this message have been removed]

__________ Information from ESET Smart Security, version of virus signature
database 3836 (20090207) __________

The message was checked by ESET Smart Security.

http://www.eset.com

[Non-text portions of this message have been removed]





__________ Information from ESET Smart Security, version of virus signature
database 3836 (20090207) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

my office isnt a member of the BBB.  The client that slammed my office on yelp
and to the BBB was putting us down because we were not a member.  The director
of the office responded back quickly to all the BBB letters that were mailed to
us.

----------
Sent from AT&T's Wireless network using Mobile Email

------Original Message------
From: Lin <italiandoll1967@...>
To: <MedicalBillers@yahoogroups.com>
Date: Sat, Feb 7, 2009 01:19 PM
Subject: RE: [MedicalBillers] Thanks Linda  :)

I want to also add that I think it is NOT in the best interest for any
healthcare provider to be a member of the BBB. I have my own opinion about
the BBB in general which I won't go into.  To be fair, if your office is a
member of the BBB your rating is not just determined by the actual number of
complaints but how you respond to them and document to the BBB, so if your
office is not responding to the complaints AND updating the BBB when you do
that is a problem.  Also you have to keep in mind HIPAA when you respond and
this is the reason I feel healthcare providers SHOULD not get involved with
the BBB, they have a right to post responses and it's just too easy to
violate HIPAA when you are trying to resolve "public" complaints.





Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry







From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of Lin
Sent: Saturday, February 07, 2009 1:12 PM
To: MedicalBillers@yahoogroups.com
Subject: RE: [MedicalBillers] Thanks Linda :)



Is your office verifying benefits and eligibility? Or are you cash pay and
leaving it up to the patient to submit? This makes a difference. If you are
billing insurance it's a good practice to do the benefits/verification from
the office and giving the patient a copy will help you eliminate problems
before they happen. If you are a cash practice and not collecting at the
time of service that can cause headaches too. You should also have patient's
read and sign the financial policy of the office.

It is not uncommon a patient will get upset when they get a bill weeks or
months later and see a balance where they don't expect to see one. That can
be fixed but it requires the office to stick with ONE procedure for all
patient's. If you are going to bill insurance then you should do the
verifications, note them in the patient file and give the patient a copy.
The form should contain the date and the person you spoke with. The
disclaimer can be at the bottom and this way the patient can take up any
problems with the carrier directly.

In any office that bills insurance it is always a good policy to do the
verifications IN the office as it will be the lifeline of the revenue.

Another idea is to post the financial policy in the office at the
receptionists desk. If you are a cash practice you can put up a sign that
says "Payment in full is expected at the time of service"

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
<http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
[mailto:MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com> ]
On Behalf Of Carol Roush
Sent: Saturday, February 07, 2009 12:48 PM
To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>

Subject: [MedicalBillers] Thanks Linda :)

Thanks so much for your help! :) We tell our clients in person and on our
office website that they are to check their benefits but they just don't. We
have so many forms that we have the clients fill out that we are not
responsible for the actions or determination of their insurance. No matter
what - we are yelled and screamed at by clients. We also have been reported
to the Better Business Bureau because of the clients insurance. I think this
is completely wrong. Now we have a rating of C on the BBB site just because
of insurance companies denying the claims. So even though we have great
speech therapists....we look bad because of an insurance company denying
someone. It's really crazy and so tiring.

Thanks again :)

Carol

--- On Sat, 2/7/09, Lin <italiandoll1967@...
<mailto:italiandoll1967%40yahoo.com>
<mailto:italiandoll1967%40yahoo.com> > wrote:

> From: Lin <italiandoll1967@... <mailto:italiandoll1967%40yahoo.com>
<mailto:italiandoll1967%40yahoo.com>
>
> Subject: RE: [MedicalBillers] Suggestions on how to word what is covered
by patients insurance company
> To: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
> Date: Saturday, February 7, 2009, 5:42 PM
> When benefits are checked by calling the carrier they all
> contain a
> disclaimer via recording or the representative will tell
> you either before
> or after they read the benefits: "Verification of
> benefits is not a
> guarantee of payment, payment is contingent upon policy and
> eligibility at
> the time services are rendered".
>
>
>
> If the office is doing the benefits and verifications there
> should be a form
> used and you can add it to the bottom ..but technically
> it's not necessary
> as the insurance company is the one libel for their
> determination. Aside
> from that the patient is responsible for knowing their own
> policies. All you
> are doing is a courtesy check for them. If the
> patient's are contacting
> their own insurance companies then again..they will be
> advised of the
> disclaimer. If you use a form to verify eligibility and
> benefits you can
> make a copy and present it to the patient if you choose.
>
>
>
> As for patient's going on a public forum or website and
> making comments.
> this is very unprofessional, however you nor the providers
> should engage in
> any activity/response and it would be to the providers
> benefit to contact
> their attorney for advice on how to handle this kind of
> situation.
>
>
>
>
>
> Linda Walker
>
> Practice Managers Resource & Networking Community
> <http://www.billerswebsite.com>
> http://www.billerswebsite.com
> A division of K&L Media, LLC
> <http://www.klmediallc.com>
> http://www.klmediallc.com
>
> Website Design & Management for the Medical Services
> Industry
>
>
>
>
>
>
>
> From: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
> [mailto:MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com> ]
> On Behalf Of Carol Roush
> Sent: Saturday, February 07, 2009 12:33 PM
> To: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
> Subject: [MedicalBillers] Suggestions on how to word what
> is covered by
> patients insurance company
>
>
>
> Hello :)
>
> Does anyone have a general statement or disclaimer they use
> to their
> patients to tell them when they ask...."What does my
> insurance cover" or
> "what are my benefits". The reason I'm asking
> is because my office has had
> some clients (we are a speech therapy office so we call
> patients, clients)
> go on Yelp.com and be very cruel to our office. Luckily, it
> wasn't me that
> was complained about on yelp. The previous receptionist
> told people what
> their insurance told her. Of course, (as insurance
> companies have their
> disclaimer) nothing is a guarantee of payment.
>
> Unfortunately, certain clients insurances have said one
> thing and then
> turned around and denied the claims. Then the office
> medical biller has to
> contact the client and tell them the bad news. So then, we
> get in trouble
> from the client and get blamed. I've only been at my
> job for 7 months.
> Everyday I learn something new and how to word things.
>
> Anyone use a disclaimer statement or your own created
> statement to let
> patients know that checking benefits and the info you got
> is no guarantee of
> coverage or insurance? My director jumped all over me just
> for saying to a
> client..."Well your insurance told me....". My
> gosh...I got in so much
> trouble from my office director. So what I do now is I tell
> clients to call
> their insurance company to get the info and I that I only
> check eligibility.
> I would like to be confident and not look like a deer in
> headlights when
> they ask the question. I don't want to say the wrong
> thing.
>
> Thanks so much for your help! :) It's very much
> appreciated!
>
> Carol :)
>
>
>
>
>
> __________ Information from ESET Smart Security, version of
> virus signature
> database 3836 (20090207) __________
>
> The message was checked by ESET Smart Security.
>
> http://www.eset.com
>
>
>
> [Non-text portions of this message have been removed]

__________ Information from ESET Smart Security, version of virus signature
database 3836 (20090207) __________

The message was checked by ESET Smart Security.

http://www.eset.com

[Non-text portions of this message have been removed]





__________ Information from ESET Smart Security, version of virus signature
database 3836 (20090207) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

Did the BBB post the information publicly? I would respond to those clients by
way of an attorney rather risking a privacy breech.





Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry







From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com] On
Behalf Of Carol Roush
Sent: Saturday, February 07, 2009 6:44 PM
To: MedicalBillers@yahoogroups.com
Subject: Re: RE: [MedicalBillers] Thanks Linda :)



my office isnt a member of the BBB. The client that slammed my office on yelp
and to the BBB was putting us down because we were not a member. The director of
the office responded back quickly to all the BBB letters that were mailed to us.

----------
Sent from AT&T's Wireless network using Mobile Email

------Original Message------
From: Lin <italiandoll1967@... <mailto:italiandoll1967%40yahoo.com> >
To: <MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com> >
Date: Sat, Feb 7, 2009 01:19 PM
Subject: RE: [MedicalBillers] Thanks Linda :)

I want to also add that I think it is NOT in the best interest for any
healthcare provider to be a member of the BBB. I have my own opinion about
the BBB in general which I won't go into. To be fair, if your office is a
member of the BBB your rating is not just determined by the actual number of
complaints but how you respond to them and document to the BBB, so if your
office is not responding to the complaints AND updating the BBB when you do
that is a problem. Also you have to keep in mind HIPAA when you respond and
this is the reason I feel healthcare providers SHOULD not get involved with
the BBB, they have a right to post responses and it's just too easy to
violate HIPAA when you are trying to resolve "public" complaints.

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
<http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com> 
[mailto:MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>
]
On Behalf Of Lin
Sent: Saturday, February 07, 2009 1:12 PM
To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>
Subject: RE: [MedicalBillers] Thanks Linda :)

Is your office verifying benefits and eligibility? Or are you cash pay and
leaving it up to the patient to submit? This makes a difference. If you are
billing insurance it's a good practice to do the benefits/verification from
the office and giving the patient a copy will help you eliminate problems
before they happen. If you are a cash practice and not collecting at the
time of service that can cause headaches too. You should also have patient's
read and sign the financial policy of the office.

It is not uncommon a patient will get upset when they get a bill weeks or
months later and see a balance where they don't expect to see one. That can
be fixed but it requires the office to stick with ONE procedure for all
patient's. If you are going to bill insurance then you should do the
verifications, note them in the patient file and give the patient a copy.
The form should contain the date and the person you spoke with. The
disclaimer can be at the bottom and this way the patient can take up any
problems with the carrier directly.

In any office that bills insurance it is always a good policy to do the
verifications IN the office as it will be the lifeline of the revenue.

Another idea is to post the financial policy in the office at the
receptionists desk. If you are a cash practice you can put up a sign that
says "Payment in full is expected at the time of service"

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
<http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
[mailto:MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com> ]
On Behalf Of Carol Roush
Sent: Saturday, February 07, 2009 12:48 PM
To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com> 
<mailto:MedicalBillers%40yahoogroups.com>

Subject: [MedicalBillers] Thanks Linda :)

Thanks so much for your help! :) We tell our clients in person and on our
office website that they are to check their benefits but they just don't. We
have so many forms that we have the clients fill out that we are not
responsible for the actions or determination of their insurance. No matter
what - we are yelled and screamed at by clients. We also have been reported
to the Better Business Bureau because of the clients insurance. I think this
is completely wrong. Now we have a rating of C on the BBB site just because
of insurance companies denying the claims. So even though we have great
speech therapists....we look bad because of an insurance company denying
someone. It's really crazy and so tiring.

Thanks again :)

Carol

--- On Sat, 2/7/09, Lin <italiandoll1967@...
<mailto:italiandoll1967%40yahoo.com>
<mailto:italiandoll1967%40yahoo.com>
<mailto:italiandoll1967%40yahoo.com> > wrote:

> From: Lin <italiandoll1967@... <mailto:italiandoll1967%40yahoo.com> 
<mailto:italiandoll1967%40yahoo.com>
<mailto:italiandoll1967%40yahoo.com>
>
> Subject: RE: [MedicalBillers] Suggestions on how to word what is covered
by patients insurance company
> To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
> Date: Saturday, February 7, 2009, 5:42 PM
> When benefits are checked by calling the carrier they all
> contain a
> disclaimer via recording or the representative will tell
> you either before
> or after they read the benefits: "Verification of
> benefits is not a
> guarantee of payment, payment is contingent upon policy and
> eligibility at
> the time services are rendered".
>
>
>
> If the office is doing the benefits and verifications there
> should be a form
> used and you can add it to the bottom ..but technically
> it's not necessary
> as the insurance company is the one libel for their
> determination. Aside
> from that the patient is responsible for knowing their own
> policies. All you
> are doing is a courtesy check for them. If the
> patient's are contacting
> their own insurance companies then again..they will be
> advised of the
> disclaimer. If you use a form to verify eligibility and
> benefits you can
> make a copy and present it to the patient if you choose.
>
>
>
> As for patient's going on a public forum or website and
> making comments.
> this is very unprofessional, however you nor the providers
> should engage in
> any activity/response and it would be to the providers
> benefit to contact
> their attorney for advice on how to handle this kind of
> situation.
>
>
>
>
>
> Linda Walker
>
> Practice Managers Resource & Networking Community
> <http://www.billerswebsite.com>
> http://www.billerswebsite.com
> A division of K&L Media, LLC
> <http://www.klmediallc.com>
> http://www.klmediallc.com
>
> Website Design & Management for the Medical Services
> Industry
>
>
>
>
>
>
>
> From: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
> [mailto:MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com> ]
> On Behalf Of Carol Roush
> Sent: Saturday, February 07, 2009 12:33 PM
> To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
<mailto:MedicalBillers%40yahoogroups.com>
> Subject: [MedicalBillers] Suggestions on how to word what
> is covered by
> patients insurance company
>
>
>
> Hello :)
>
> Does anyone have a general statement or disclaimer they use
> to their
> patients to tell them when they ask...."What does my
> insurance cover" or
> "what are my benefits". The reason I'm asking
> is because my office has had
> some clients (we are a speech therapy office so we call
> patients, clients)
> go on Yelp.com and be very cruel to our office. Luckily, it
> wasn't me that
> was complained about on yelp. The previous receptionist
> told people what
> their insurance told her. Of course, (as insurance
> companies have their
> disclaimer) nothing is a guarantee of payment.
>
> Unfortunately, certain clients insurances have said one
> thing and then
> turned around and denied the claims. Then the office
> medical biller has to
> contact the client and tell them the bad news. So then, we
> get in trouble
> from the client and get blamed. I've only been at my
> job for 7 months.
> Everyday I learn something new and how to word things.
>
> Anyone use a disclaimer statement or your own created
> statement to let
> patients know that checking benefits and the info you got
> is no guarantee of
> coverage or insurance? My director jumped all over me just
> for saying to a
> client..."Well your insurance told me....". My
> gosh...I got in so much
> trouble from my office director. So what I do now is I tell
> clients to call
> their insurance company to get the info and I that I only
> check eligibility.
> I would like to be confident and not look like a deer in
> headlights when
> they ask the question. I don't want to say the wrong
> thing.
>
> Thanks so much for your help! :) It's very much
> appreciated!
>
> Carol :)
>
>
>
>
>
> __________ Information from ESET Smart Security, version of
> virus signature
> database 3836 (20090207) __________
>
> The message was checked by ESET Smart Security.
>
> http://www.eset.com
>
>
>
> [Non-text portions of this message have been removed]

__________ Information from ESET Smart Security, version of virus signature
database 3836 (20090207) __________

The message was checked by ESET Smart Security.

http://www.eset.com

[Non-text portions of this message have been removed]

__________ Information from ESET Smart Security, version of virus signature
database 3836 (20090207) __________

The message was checked by ESET Smart Security.

http://www.eset.com

[Non-text portions of this message have been removed]





__________ Information from ESET Smart Security, version of virus signature
database 3836 (20090207) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

Hello,
When 2 insurance policies are involved, my impression was that the
patient's own policy is always primary and the policy through the
spouse is secondary.

I have a situation where the primary policy did not pay some of the
claims because patient did not update her records/specify a
physician.  When she called to update this info, she found out that
her PCP is a non-participating provider.  She says that she was
instructed to bill all treatment (visits with the provider I work
for) to her secondary policy (under husband's name). This doesn't
make sense to me because PCP referral was not required (she has an
Open Access plan), the provider I work for is a participating
provider, plus we had the authorization that was needed. It doesn't
seem like there is a reason why the provider I work for should not
get paid.

I am getting conflicting information from the patient and the
insurance company.  Is it ever correct to bill treatment to secondary
insurance, bypassing the primary policy due to PCP issues? Will the
secondary policy pay the allowable amount in full?

Thank you for your help!
Marta

Carol,

Here's my standard reply to patients who ask if the service today is
covered by their insurance company.

I say "you can call them and find out.  It's up to you to know your
benefits and if it's not covered, then we will send you a bill."  Of
course, if we are doing services that are questionable and may need
an ABN, then we are checking those benefits in advance; if we can,
and notify the patient at the time of service.

I also tell them "there are so many insurances out there and we can't
possibly know what every patient's benefits are, with their employer
group.  If you have questions, you need to contact the insurance
company, or consult your benefits book provided by your employer."

Hope that helps!

Melinda Brown, CMBS
Ins Biller


--- In MedicalBillers@yahoogroups.com, Carol Roush <carol.roush@...>
wrote:
>
> Hello  :)
>
> Does anyone have a general statement or disclaimer they use to
their patients to tell them when they ask...."What does my insurance
cover" or "what are my benefits".  The reason I'm asking is because
my office has had some clients (we are a speech therapy office so we
call patients, clients) go on Yelp.com and be very cruel to our
office.  Luckily, it wasn't me that was complained about on yelp.
The previous receptionist told people what their insurance told her.
Of course, (as insurance companies have their disclaimer) nothing is
a guarantee of payment.
>
> Unfortunately, certain clients insurances have said one thing and
then turned around and denied the claims.  Then the office medical
biller has to contact the client and tell them the bad news.  So
then, we get in trouble from the client and get blamed.  I've only
been at my job for 7 months.  Everyday I learn something new and how
to word things.
>
> Anyone use a disclaimer statement or your own created statement to
let patients know that checking benefits and the info you got is no
guarantee of coverage or insurance?  My director jumped all over me
just for saying to a client..."Well your insurance told me....".  My
gosh...I got in so much trouble from my office director.  So what I
do now is I tell clients to call their insurance company to get the
info and I that I only check eligibility.  I would like to be
confident and not look like a deer in headlights when they ask the
question.  I don't want to say the wrong thing.
>
> Thanks so much for your help!  :)  It's very much appreciated!
>
> Carol  :)
>

Marta,

2 insurances:  If the patient is employed and also has coverage
through a spouse, then the patient's insurance is always primary and
the spouse's is secondary.  Exception: children, then be sure to
apply the birthday rule:

http://www.insure.com/articles/healthinsurance/birthday-rule.html
<http://www.insure.com/articles/healthinsurance/birthday-rule.html>

Since the PCP is non-par, after she updated her records, then she may
have more out-of-pocket to pay.  Did the EOB indicate a contractual
adjustment?  If so, and you're non-par (I'm assuming you mean non-
contracted by non-par), then you shouldn't have to take it.  Bill the
full balance due onto the secondary insurance.

You stated that your provider is contracted by that primary insurance
co.  I'd be making a call to your provider relations/contracting
rep., because they processed you as out-of-network, instead of in.
They need to update your records and have the claims reprocessed at
the in-network benefits level.

You stated "She says that she was instructed to bill all treatment
(visits with the provider I work for) to her secondary policy (under
husband's name)."  I'm assuming you mean the patient was instructed
by the insurance co?

I'm really thinking that this is sounding more like a contracting
issue, as I'm working through my thoughts.  I'd get a hold of your
provider relations rep, and have them double check your provider's
files...there may be an error.

One other option you have...if you are still seeing this patient, is
to tell them that you are not a contracted provider with that
insurance company and give them the option of going to an in-network
provider.  I've given patients that option, esp. if we are still
going through contracting, but they always stay with us.

Your questions:

1) "Is it ever correct to bill treatment to secondary insurance,
bypassing the primary policy due to PCP issues?"

The answer is no. You should contact the patient as soon as you know
it's an issue and try to fix, if possible.


2) "Will the secondary policy pay the allowable amount in full?"

The answer is no and it's due to coordination of benefits. The
secondary insurance will pay up to their maximum allowable, if the
primary hasn't paid.

Insurances talk to each other and most of them know who is primary &
secondary.  Most of them will deny, if you haven't billed the primary
insurance first and request an EOB.

Here's the Wash. State Law on COB:
http://apps.leg.wa.gov/WAC/default.aspx?cite=284-51-260
<http://apps.leg.wa.gov/WAC/default.aspx?cite=284-51-260>

You can email me if you have further questions, or I wasn't
understanding you correctly.  I hope that helps.

Melinda Brown, CMBS
Ins Biller
--- In MedicalBillers@yahoogroups.com, "Marta Sanders" <martasan@...>
wrote:
>
> Hello,
> When 2 insurance policies are involved, my impression was that the
> patient's own policy is always primary and the policy through the
> spouse is secondary.
>
> I have a situation where the primary policy did not pay some of the
> claims because patient did not update her records/specify a
> physician. When she called to update this info, she found out that
> her PCP is a non-participating provider. She says that she was
> instructed to bill all treatment (visits with the provider I work
> for) to her secondary policy (under husband's name). This doesn't
> make sense to me because PCP referral was not required (she has an
> Open Access plan), the provider I work for is a participating
> provider, plus we had the authorization that was needed. It doesn't
> seem like there is a reason why the provider I work for should not
> get paid.
>
> I am getting conflicting information from the patient and the
> insurance company. Is it ever correct to bill treatment to secondary
> insurance, bypassing the primary policy due to PCP issues? Will the
> secondary policy pay the allowable amount in full?
>
> Thank you for your help!
> Marta
>




[Non-text portions of this message have been removed]

That is practical if you are a cash practice, but if you are billing
insurance and relying on insurance revenue it's not practical and it's in
the best interest of the practice to verify benefits and/or eligibility.

But again if you are accepting all payments at the time of service this is a
good plan.





Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry







From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of Melinda
Sent: Monday, February 09, 2009 1:49 AM
To: MedicalBillers@yahoogroups.com
Subject: [MedicalBillers] Re: Suggestions on how to word what is covered by
patients insurance company



Carol,

Here's my standard reply to patients who ask if the service today is
covered by their insurance company.

I say "you can call them and find out. It's up to you to know your
benefits and if it's not covered, then we will send you a bill." Of
course, if we are doing services that are questionable and may need
an ABN, then we are checking those benefits in advance; if we can,
and notify the patient at the time of service.

I also tell them "there are so many insurances out there and we can't
possibly know what every patient's benefits are, with their employer
group. If you have questions, you need to contact the insurance
company, or consult your benefits book provided by your employer."

Hope that helps!

Melinda Brown, CMBS
Ins Biller

--- In MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com> , Carol Roush <carol.roush@...>
wrote:
>
> Hello :)
>
> Does anyone have a general statement or disclaimer they use to
their patients to tell them when they ask...."What does my insurance
cover" or "what are my benefits". The reason I'm asking is because
my office has had some clients (we are a speech therapy office so we
call patients, clients) go on Yelp.com and be very cruel to our
office. Luckily, it wasn't me that was complained about on yelp.
The previous receptionist told people what their insurance told her.
Of course, (as insurance companies have their disclaimer) nothing is
a guarantee of payment.
>
> Unfortunately, certain clients insurances have said one thing and
then turned around and denied the claims. Then the office medical
biller has to contact the client and tell them the bad news. So
then, we get in trouble from the client and get blamed. I've only
been at my job for 7 months. Everyday I learn something new and how
to word things.
>
> Anyone use a disclaimer statement or your own created statement to
let patients know that checking benefits and the info you got is no
guarantee of coverage or insurance? My director jumped all over me
just for saying to a client..."Well your insurance told me....". My
gosh...I got in so much trouble from my office director. So what I
do now is I tell clients to call their insurance company to get the
info and I that I only check eligibility. I would like to be
confident and not look like a deer in headlights when they ask the
question. I don't want to say the wrong thing.
>
> Thanks so much for your help! :) It's very much appreciated!
>
> Carol :)
>





__________ Information from ESET Smart Security, version of virus signature
database 3837 (20090208) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

Her insurance would be primary, his would be secondary, hers would
HAVE to billed first, even if they don't cover a dime,  in order to
have their EOB to send into the 2ndry, then the 2ndry should
(hopefully) cover the balance, and at that point if the 2ndry didn't,
then the patient would be responsible as both of her
companies/policies are not paying.

That's how we would do it.

Tanya





--- In MedicalBillers@yahoogroups.com, "Marta Sanders" <martasan@...>
wrote:
>
> Hello,
> When 2 insurance policies are involved, my impression was that the
> patient's own policy is always primary and the policy through the
> spouse is secondary.
>
> I have a situation where the primary policy did not pay some of the
> claims because patient did not update her records/specify a
> physician.  When she called to update this info, she found out that
> her PCP is a non-participating provider.  She says that she was
> instructed to bill all treatment (visits with the provider I work
> for) to her secondary policy (under husband's name). This doesn't
> make sense to me because PCP referral was not required (she has an
> Open Access plan), the provider I work for is a participating
> provider, plus we had the authorization that was needed. It doesn't
> seem like there is a reason why the provider I work for should not
> get paid.
>
> I am getting conflicting information from the patient and the
> insurance company.  Is it ever correct to bill treatment to
secondary
> insurance, bypassing the primary policy due to PCP issues? Will the
> secondary policy pay the allowable amount in full?
>
> Thank you for your help!
> Marta
>

Melinda,

Thank you for your suggestions.  I will memorize those too when people ask me.

Carol


--- On Mon, 2/9/09, Melinda <melindadocsmith@...> wrote:

> From: Melinda <melindadocsmith@...>
> Subject: [MedicalBillers] Re: Suggestions on how to word what is covered by
patients insurance company
> To: MedicalBillers@yahoogroups.com
> Date: Monday, February 9, 2009, 6:49 AM
> Carol,
>
> Here's my standard reply to patients who ask if the
> service today is
> covered by their insurance company.
>
> I say "you can call them and find out.  It's up to
> you to know your
> benefits and if it's not covered, then we will send you
> a bill."  Of
> course, if we are doing services that are questionable and
> may need
> an ABN, then we are checking those benefits in advance; if
> we can,
> and notify the patient at the time of service.
>
> I also tell them "there are so many insurances out
> there and we can't
> possibly know what every patient's benefits are, with
> their employer
> group.  If you have questions, you need to contact the
> insurance
> company, or consult your benefits book provided by your
> employer."
>
> Hope that helps!
>
> Melinda Brown, CMBS
> Ins Biller
>
>
> --- In MedicalBillers@yahoogroups.com, Carol Roush
> <carol.roush@...>
> wrote:
> >
> > Hello  :)
> >
> > Does anyone have a general statement or disclaimer
> they use to
> their patients to tell them when they ask...."What
> does my insurance
> cover" or "what are my benefits".  The
> reason I'm asking is because
> my office has had some clients (we are a speech therapy
> office so we
> call patients, clients) go on Yelp.com and be very cruel to
> our
> office.  Luckily, it wasn't me that was complained
> about on yelp.
> The previous receptionist told people what their insurance
> told her.
> Of course, (as insurance companies have their disclaimer)
> nothing is
> a guarantee of payment.
> >
> > Unfortunately, certain clients insurances have said
> one thing and
> then turned around and denied the claims.  Then the office
> medical
> biller has to contact the client and tell them the bad
> news.  So
> then, we get in trouble from the client and get blamed.
> I've only
> been at my job for 7 months.  Everyday I learn something
> new and how
> to word things.
> >
> > Anyone use a disclaimer statement or your own created
> statement to
> let patients know that checking benefits and the info you
> got is no
> guarantee of coverage or insurance?  My director jumped all
> over me
> just for saying to a client..."Well your insurance
> told me....".  My
> gosh...I got in so much trouble from my office director.
> So what I
> do now is I tell clients to call their insurance company to
> get the
> info and I that I only check eligibility.  I would like to
> be
> confident and not look like a deer in headlights when they
> ask the
> question.  I don't want to say the wrong thing.
> >
> > Thanks so much for your help!  :)  It's very much
> appreciated!
> >
> > Carol  :)
> >

My office accept cash and we accept most insurances (which where I live, is rare
being a speech therapy office).


--- On Mon, 2/9/09, Lin <italiandoll1967@...> wrote:

> From: Lin <italiandoll1967@...>
> Subject: RE: [MedicalBillers] Re: Suggestions on how to word what is covered
by patients insurance company
> To: MedicalBillers@yahoogroups.com
> Date: Monday, February 9, 2009, 12:10 PM
> That is practical if you are a cash practice, but if you are
> billing
> insurance and relying on insurance revenue it's not
> practical and it's in
> the best interest of the practice to verify benefits and/or
> eligibility.
>
> But again if you are accepting all payments at the time of
> service this is a
> good plan.
>
>
>
>
>
> Linda Walker
>
> Practice Managers Resource & Networking Community
>  <http://www.billerswebsite.com>
> http://www.billerswebsite.com
> A division of K&L Media, LLC
>  <http://www.klmediallc.com>
> http://www.klmediallc.com
>
> Website Design & Management for the Medical Services
> Industry
>
>
>
>
>
>
>
> From: MedicalBillers@yahoogroups.com
> [mailto:MedicalBillers@yahoogroups.com]
> On Behalf Of Melinda
> Sent: Monday, February 09, 2009 1:49 AM
> To: MedicalBillers@yahoogroups.com
> Subject: [MedicalBillers] Re: Suggestions on how to word
> what is covered by
> patients insurance company
>
>
>
> Carol,
>
> Here's my standard reply to patients who ask if the
> service today is
> covered by their insurance company.
>
> I say "you can call them and find out. It's up to
> you to know your
> benefits and if it's not covered, then we will send you
> a bill." Of
> course, if we are doing services that are questionable and
> may need
> an ABN, then we are checking those benefits in advance; if
> we can,
> and notify the patient at the time of service.
>
> I also tell them "there are so many insurances out
> there and we can't
> possibly know what every patient's benefits are, with
> their employer
> group. If you have questions, you need to contact the
> insurance
> company, or consult your benefits book provided by your
> employer."
>
> Hope that helps!
>
> Melinda Brown, CMBS
> Ins Biller
>
> --- In MedicalBillers@yahoogroups.com
> <mailto:MedicalBillers%40yahoogroups.com> , Carol
> Roush <carol.roush@...>
> wrote:
> >
> > Hello :)
> >
> > Does anyone have a general statement or disclaimer
> they use to
> their patients to tell them when they ask...."What
> does my insurance
> cover" or "what are my benefits". The reason
> I'm asking is because
> my office has had some clients (we are a speech therapy
> office so we
> call patients, clients) go on Yelp.com and be very cruel to
> our
> office. Luckily, it wasn't me that was complained about
> on yelp.
> The previous receptionist told people what their insurance
> told her.
> Of course, (as insurance companies have their disclaimer)
> nothing is
> a guarantee of payment.
> >
> > Unfortunately, certain clients insurances have said
> one thing and
> then turned around and denied the claims. Then the office
> medical
> biller has to contact the client and tell them the bad
> news. So
> then, we get in trouble from the client and get blamed.
> I've only
> been at my job for 7 months. Everyday I learn something new
> and how
> to word things.
> >
> > Anyone use a disclaimer statement or your own created
> statement to
> let patients know that checking benefits and the info you
> got is no
> guarantee of coverage or insurance? My director jumped all
> over me
> just for saying to a client..."Well your insurance
> told me....". My
> gosh...I got in so much trouble from my office director. So
> what I
> do now is I tell clients to call their insurance company to
> get the
> info and I that I only check eligibility. I would like to
> be
> confident and not look like a deer in headlights when they
> ask the
> question. I don't want to say the wrong thing.
> >
> > Thanks so much for your help! :) It's very much
> appreciated!
> >
> > Carol :)
> >
>
>
>
>
>
> __________ Information from ESET Smart Security, version of
> virus signature
> database 3837 (20090208) __________
>
> The message was checked by ESET Smart Security.
>
> http://www.eset.com
>
>
>
> [Non-text portions of this message have been removed]

Hi Carol,
I have worked in Chiropractic offices, and many of those services also would not
be covered.  We used to tell the patients that as a courtesy we will bill their
insurance for them, however their policy was an agreement between them and their
insurance company; not our office and the insurance company.  We would also then
explain the disclaimer that the insurance company gave to us "this is a quote of
benefits, not a guarantee of payment".  We had that on our financial policy as
well, and had the patient sign it.  For the most part, patients would not
question the benefits.  I hope that helps a little
Patty



________________________________
From: Carol Roush <carol.roush@...>
To: MedicalBillers@yahoogroups.com
Sent: Tuesday, February 10, 2009 6:54:27 PM
Subject: RE: [MedicalBillers] Re: Suggestions on how to word what is covered by
patients insurance company


My office accept cash and we accept most insurances (which where I live, is rare
being a speech therapy office).

--- On Mon, 2/9/09, Lin <italiandoll1967@ yahoo.com> wrote:

> From: Lin <italiandoll1967@ yahoo.com>
> Subject: RE: [MedicalBillers] Re: Suggestions on how to word what is covered
by patients insurance company
> To: MedicalBillers@ yahoogroups. com
> Date: Monday, February 9, 2009, 12:10 PM
> That is practical if you are a cash practice, but if you are
> billing
> insurance and relying on insurance revenue it's not
> practical and it's in
> the best interest of the practice to verify benefits and/or
> eligibility.
>
> But again if you are accepting all payments at the time of
> service this is a
> good plan.
>
>
>
>
>
> Linda Walker
>
> Practice Managers Resource & Networking Community
> <http://www.billersw ebsite.com>
> http://www.billersw ebsite.com
> A division of K&L Media, LLC
> <http://www.klmedial lc.com>
> http://www.klmedial lc.com
>
> Website Design & Management for the Medical Services
> Industry
>
>
>
>
>
>
>
> From: MedicalBillers@ yahoogroups. com
> [mailto:MedicalBillers@ yahoogroups. com]
> On Behalf Of Melinda
> Sent: Monday, February 09, 2009 1:49 AM
> To: MedicalBillers@ yahoogroups. com
> Subject: [MedicalBillers] Re: Suggestions on how to word
> what is covered by
> patients insurance company
>
>
>
> Carol,
>
> Here's my standard reply to patients who ask if the
> service today is
> covered by their insurance company.
>
> I say "you can call them and find out. It's up to
> you to know your
> benefits and if it's not covered, then we will send you
> a bill." Of
> course, if we are doing services that are questionable and
> may need
> an ABN, then we are checking those benefits in advance; if
> we can,
> and notify the patient at the time of service.
>
> I also tell them "there are so many insurances out
> there and we can't
> possibly know what every patient's benefits are, with
> their employer
> group. If you have questions, you need to contact the
> insurance
> company, or consult your benefits book provided by your
> employer."
>
> Hope that helps!
>
> Melinda Brown, CMBS
> Ins Biller
>
> --- In MedicalBillers@ yahoogroups. com
> <mailto:MedicalBill ers%40yahoogroup s.com> , Carol
> Roush <carol.roush@ ...>
> wrote:
> >
> > Hello :)
> >
> > Does anyone have a general statement or disclaimer
> they use to
> their patients to tell them when they ask...."What
> does my insurance
> cover" or "what are my benefits". The reason
> I'm asking is because
> my office has had some clients (we are a speech therapy
> office so we
> call patients, clients) go on Yelp.com and be very cruel to
> our
> office. Luckily, it wasn't me that was complained about
> on yelp.
> The previous receptionist told people what their insurance
> told her.
> Of course, (as insurance companies have their disclaimer)
> nothing is
> a guarantee of payment.
> >
> > Unfortunately, certain clients insurances have said
> one thing and
> then turned around and denied the claims. Then the office
> medical
> biller has to contact the client and tell them the bad
> news. So
> then, we get in trouble from the client and get blamed.
> I've only
> been at my job for 7 months. Everyday I learn something new
> and how
> to word things.
> >
> > Anyone use a disclaimer statement or your own created
> statement to
> let patients know that checking benefits and the info you
> got is no
> guarantee of coverage or insurance? My director jumped all
> over me
> just for saying to a client..."Well your insurance
> told me....". My
> gosh...I got in so much trouble from my office director. So
> what I
> do now is I tell clients to call their insurance company to
> get the
> info and I that I only check eligibility. I would like to
> be
> confident and not look like a deer in headlights when they
> ask the
> question. I don't want to say the wrong thing.
> >
> > Thanks so much for your help! :) It's very much
> appreciated!
> >
> > Carol :)
> >
>
>
>
>
>
> __________ Information from ESET Smart Security, version of
> virus signature
> database 3837 (20090208) __________
>
> The message was checked by ESET Smart Security.
>
> http://www.eset. com
>
>
>
> [Non-text portions of this message have been removed]







[Non-text portions of this message have been removed]

Thanks Patty  :)

I have written down all this info and shared it with my director.

Carol


--- On Thu, 2/12/09, Patty Shutt <shuttpatty@...> wrote:

> From: Patty Shutt <shuttpatty@...>
> Subject: Re: [MedicalBillers] Re: Suggestions on how to word what is covered
by patients insurance company
> To: MedicalBillers@yahoogroups.com
> Date: Thursday, February 12, 2009, 7:28 PM
> Hi Carol,
> I have worked in Chiropractic offices, and many of those
> services also would not be covered.  We used to tell the
> patients that as a courtesy we will bill their
> insurance for them, however their policy was an
> agreement between them and their insurance company; not our
> office and the insurance company.  We would also then
> explain the disclaimer that the insurance company gave to us
> "this is a quote of benefits, not a guarantee of
> payment".  We had that on our financial policy as
> well, and had the patient sign it.  For the most part,
> patients would not question the benefits.  I hope that
> helps a little
> Patty
>
>
>
> ________________________________
> From: Carol Roush <carol.roush@...>
> To: MedicalBillers@yahoogroups.com
> Sent: Tuesday, February 10, 2009 6:54:27 PM
> Subject: RE: [MedicalBillers] Re: Suggestions on how to
> word what is covered by patients insurance company
>
>
> My office accept cash and we accept most insurances (which
> where I live, is rare being a speech therapy office).
>
> --- On Mon, 2/9/09, Lin <italiandoll1967@ yahoo.com>
> wrote:
>
> > From: Lin <italiandoll1967@ yahoo.com>
> > Subject: RE: [MedicalBillers] Re: Suggestions on how
> to word what is covered by patients insurance company
> > To: MedicalBillers@ yahoogroups. com
> > Date: Monday, February 9, 2009, 12:10 PM
> > That is practical if you are a cash practice, but if
> you are
> > billing
> > insurance and relying on insurance revenue it's
> not
> > practical and it's in
> > the best interest of the practice to verify benefits
> and/or
> > eligibility.
> >
> > But again if you are accepting all payments at the
> time of
> > service this is a
> > good plan.
> >
> >
> >
> >
> >
> > Linda Walker
> >
> > Practice Managers Resource & Networking Community
> > <http://www.billersw ebsite.com>
> > http://www.billersw ebsite.com
> > A division of K&L Media, LLC
> > <http://www.klmedial lc.com>
> > http://www.klmedial lc.com
> >
> > Website Design & Management for the Medical
> Services
> > Industry
> >
> >
> >
> >
> >
> >
> >
> > From: MedicalBillers@ yahoogroups. com
> > [mailto:MedicalBillers@ yahoogroups. com]
> > On Behalf Of Melinda
> > Sent: Monday, February 09, 2009 1:49 AM
> > To: MedicalBillers@ yahoogroups. com
> > Subject: [MedicalBillers] Re: Suggestions on how to
> word
> > what is covered by
> > patients insurance company
> >
> >
> >
> > Carol,
> >
> > Here's my standard reply to patients who ask if
> the
> > service today is
> > covered by their insurance company.
> >
> > I say "you can call them and find out. It's
> up to
> > you to know your
> > benefits and if it's not covered, then we will
> send you
> > a bill." Of
> > course, if we are doing services that are questionable
> and
> > may need
> > an ABN, then we are checking those benefits in
> advance; if
> > we can,
> > and notify the patient at the time of service.
> >
> > I also tell them "there are so many insurances
> out
> > there and we can't
> > possibly know what every patient's benefits are,
> with
> > their employer
> > group. If you have questions, you need to contact the
> > insurance
> > company, or consult your benefits book provided by
> your
> > employer."
> >
> > Hope that helps!
> >
> > Melinda Brown, CMBS
> > Ins Biller
> >
> > --- In MedicalBillers@ yahoogroups. com
> > <mailto:MedicalBill ers%40yahoogroup s.com> ,
> Carol
> > Roush <carol.roush@ ...>
> > wrote:
> > >
> > > Hello :)
> > >
> > > Does anyone have a general statement or
> disclaimer
> > they use to
> > their patients to tell them when they
> ask...."What
> > does my insurance
> > cover" or "what are my benefits". The
> reason
> > I'm asking is because
> > my office has had some clients (we are a speech
> therapy
> > office so we
> > call patients, clients) go on Yelp.com and be very
> cruel to
> > our
> > office. Luckily, it wasn't me that was complained
> about
> > on yelp.
> > The previous receptionist told people what their
> insurance
> > told her.
> > Of course, (as insurance companies have their
> disclaimer)
> > nothing is
> > a guarantee of payment.
> > >
> > > Unfortunately, certain clients insurances have
> said
> > one thing and
> > then turned around and denied the claims. Then the
> office
> > medical
> > biller has to contact the client and tell them the bad
> > news. So
> > then, we get in trouble from the client and get
> blamed.
> > I've only
> > been at my job for 7 months. Everyday I learn
> something new
> > and how
> > to word things.
> > >
> > > Anyone use a disclaimer statement or your own
> created
> > statement to
> > let patients know that checking benefits and the info
> you
> > got is no
> > guarantee of coverage or insurance? My director jumped
> all
> > over me
> > just for saying to a client..."Well your
> insurance
> > told me....". My
> > gosh...I got in so much trouble from my office
> director. So
> > what I
> > do now is I tell clients to call their insurance
> company to
> > get the
> > info and I that I only check eligibility. I would like
> to
> > be
> > confident and not look like a deer in headlights when
> they
> > ask the
> > question. I don't want to say the wrong thing.
> > >
> > > Thanks so much for your help! :) It's very
> much
> > appreciated!
> > >
> > > Carol :)
> > >
> >
> >
> >
> >
> >
> > __________ Information from ESET Smart Security,
> version of
> > virus signature
> > database 3837 (20090208) __________
> >
> > The message was checked by ESET Smart Security.
> >
> > http://www.eset. com
> >
> >
> >
> > [Non-text portions of this message have been removed]
>
>
>
>
>
>
>
> [Non-text portions of this message have been removed]

Hello,

I'm seriously about to give up on the faith in some people.  Once again, another
client got denied from BlueShield because the diagnosis code is not medically
necessary due to BlueShield.  Of course, the parent lashes out at the medical
biller and told her that she does the medical billing all wrong.  This parent
even asked us to change the diagnosis code so that it is medically necessary. 
The medical biller in my office explained to the parent that it's fraud to do
that and we refuse to do so!

I'm starting to think that I'm the receptionist for a office that has to deal
with some crazy people.  It's draining.  I'm tired of being told that we told
people that they were covered when we NEVER said that.

Is it just my office that has to deal with wacky people???  I'm starting to
think I work for an office that just has bad luck or something!  Now I'm
thinking...here goes another client to Yelp to complain about us over something
that their insurance did to them - not the office I work for!

Thanks,

Carol

You are not alone.  I definitely am seeing a lot more crazed patients upset
with the way their ins has paid and blue shield is the worst at telling them
its the doctors office fault for coding it the way they did.  We get those
calls daily and its enough to tear your hair out for sure!   We are going to
work up a letter to give to the patients for all procedures telling them
that their insurance may put the dx code to preventative or to medical
depending on their benefits and the outcome of their procedure.  Please call
them to ascertain what the payment will likely be for either scenario.  I am
hoping that that will engage those patients to make those calls PRIOR to
receiving an EOB or bill from us and hollaring after the fact.  It is
getting very wearing on the morale of the office.  Yikes.

Vicki F

-------Original Message-------

From: Carol Roush
Date: 2/14/2009 5:34:10 PM
To: MedicalBillers@yahoogroups.com
Subject: [MedicalBillers] Tired of clients taking their frustrations out on
the office for they didn't call their insurance

Hello,

I'm seriously about to give up on the faith in some people. Once again,
another client got denied from BlueShield because the diagnosis code is not
medically necessary due to BlueShield. Of course, the parent lashes out at
the medical biller and told her that she does the medical billing all wrong.
This parent even asked us to change the diagnosis code so that it is
medically necessary. The medical biller in my office explained to the parent
that it's fraud to do that and we refuse to do so!

I'm starting to think that I'm the receptionist for a office that has to
deal with some crazy people. It's draining. I'm tired of being told that we
told people that they were covered when we NEVER said that.

Is it just my office that has to deal with wacky people??? I'm starting to
think I work for an office that just has bad luck or something! Now I'm
thinking...here goes another client to Yelp to complain about us over
something that their insurance did to them - not the office I work for!

Thanks,

Carol





[Non-text portions of this message have been removed]

Wacky patients, Wacky providers, wacky front desk people, ...........  do you
see a pattern forming.  Oh I forgot, WACKY EMPLOYEES,  there my rant is done. 
You will love when a client doesn't want to pay the exit fee because things are
uncollectable  because of their actions and you still want your exit fee from
the work.
 
Maryann

--- On Sat, 2/14/09, Carol Roush <carol.roush@...> wrote:

From: Carol Roush <carol.roush@...>
Subject: [MedicalBillers] Tired of clients taking their frustrations out on the
office for they didn't call their insurance
To: MedicalBillers@yahoogroups.com
Date: Saturday, February 14, 2009, 8:34 PM






Hello,

I'm seriously about to give up on the faith in some people. Once again, another
client got denied from BlueShield because the diagnosis code is not medically
necessary due to BlueShield. Of course, the parent lashes out at the medical
biller and told her that she does the medical billing all wrong. This parent
even asked us to change the diagnosis code so that it is medically necessary.
The medical biller in my office explained to the parent that it's fraud to do
that and we refuse to do so!

I'm starting to think that I'm the receptionist for a office that has to deal
with some crazy people. It's draining. I'm tired of being told that we told
people that they were covered when we NEVER said that.

Is it just my office that has to deal with wacky people??? I'm starting to think
I work for an office that just has bad luck or something! Now I'm
thinking...here goes another client to Yelp to complain about us over something
that their insurance did to them - not the office I work for!

Thanks,

Carol
















[Non-text portions of this message have been removed]

there could possibly be another answer to this... did you look at the notes? was
there more than one diagnosis and they just gave you the wrong one for the code?
have you thought about giving that specific provider the list of codes that
are acceptable for that cpt? that way.. they know up front what will be paid and
what will not.. and you can refer back to it if something denies... just a
thought!!
 Life isn't about waiting for the storm to pass, it's about learning to dance in
the rain!!


~Michelle~




________________________________
From: Maryann Burke <chiroblr@...>
To: MedicalBillers@yahoogroups.com
Sent: Sunday, February 15, 2009 7:16:46 AM
Subject: Re: [MedicalBillers] Tired of clients taking their frustrations out on
the office for they didn't call their insurance


Wacky patients, Wacky providers, wacky front desk people, ...........  do you
see a pattern forming.  Oh I forgot, WACKY EMPLOYEES,  there my rant is done. 
You will love when a client doesn't want to pay the exit fee because things are
uncollectable  because of their actions and you still want your exit fee from
the work.
 
Maryann

--- On Sat, 2/14/09, Carol Roush <carol.roush@ yahoo.com> wrote:

From: Carol Roush <carol.roush@ yahoo.com>
Subject: [MedicalBillers] Tired of clients taking their frustrations out on the
office for they didn't call their insurance
To: MedicalBillers@ yahoogroups. com
Date: Saturday, February 14, 2009, 8:34 PM

Hello,

I'm seriously about to give up on the faith in some people. Once again, another
client got denied from BlueShield because the diagnosis code is not medically
necessary due to BlueShield. Of course, the parent lashes out at the medical
biller and told her that she does the medical billing all wrong. This parent
even asked us to change the diagnosis code so that it is medically necessary.
The medical biller in my office explained to the parent that it's fraud to do
that and we refuse to do so!

I'm starting to think that I'm the receptionist for a office that has to deal
with some crazy people. It's draining. I'm tired of being told that we told
people that they were covered when we NEVER said that.

Is it just my office that has to deal with wacky people??? I'm starting to think
I work for an office that just has bad luck or something! Now I'm
thinking...here goes another client to Yelp to complain about us over something
that their insurance did to them - not the office I work for!

Thanks,

Carol

[Non-text portions of this message have been removed]







[Non-text portions of this message have been removed]

That's a comfort...well, in a odd way I guess.  I mean, at least I know other
offices are going through the same wacky drama.  I absolutely detest BlueShield.
I cringe when a client has told me that their new insurance is BlueShield.  I
really want to ask the client, "Really?  Are you sure?!?!?"  I look at the card
and a sick feeling comes over me.  Then I call on the benefits and my heart just
sinks for the adult or child that really needs the speech therapy.  All stupid
BlueShield has given them is 12 visits...for one year?!?!?   Aggghhh!!  The
medical biller does check the codes and the codes on the speech therapy reports
given to her by the therapists.

My Director has Office Policies that are 5 pages long.  No joke and it's all due
to the craziness of people not showing up for appointments and insurance stuff. 
After the first former client went to yelp complaining about us because their
insurance denied them, we now have a diagnosis code explanation document for
clients or parents of clients to sign.  I get nasty comments given to me about
the office policies and how long they are.  My Director felt that it had to be
stated and signed.  I just make jokes now back to the nasty comments
like...."After I give you a copy, please take it home and there will be a test
next time".  Hehehe  :)  Or I say...."Well, you know there are always those few
bad apples that make it tough for everyone else".

On our office website, we even tell people to call their benefits and even
outline what they should ask!  I tell them on the phone when i do the intake
call.  I tell them that we only check eligibility and if their insurance is
active.  I know that clients or parents of clients don't check their insurance
due to the invoices they are receiving from my office now.  They freak out when
they see the big amount.  I usually have to ask, "Um, do you have a deductible
that you forgot about that renews at the beginning of each year"?  Then they
say...Ohhhhhhh.  That's when I redirect them to their insurance customer service
#800 on the back of their card.

What I think is crazy is that the Director of the speech clinic doesn't make
client or parents of clients pay each time at their appt.  I pay each time when
I go to my doctor and that's how I was trained in Medical Receptionist classes. 
Private pay people have to pay each time but the insurance clients don't have
to, if they don't want.

Sorry for ranting again.  Thanks for reading and I feel a bit better that I'm
not the only one dealing with wacky people!

Thanks so much,

Carol  :)