Practitioner pointer: Tracking your patients’ insurance coverage

Why you should discuss and confirm insurance coverage with all of your patients regularly.

With the end of the year approaching, many people are evaluating their insurance coverage and enrolling for coverage for 2015 — whether through their employer or a health insurance exchange. But there are other instances when a person’s insurance coverage may change during the calendar year. 

As related to health insurance exchanges, income is a primary factor in determining coverage eligibility and whether someone qualifies for Medicaid or an individual plan through the exchange. Some individuals may end up shifting between health insurance exchange plans and Medicaid due to fluctuations in income. Another example of a shift in insurance coverage: When someone with employer-sponsored insurance coverage changes jobs, his or her insurance benefits will change, too.

So, as recommended in the APA Ethics Code Section 10.01, it is wise to discuss insurance coverage and payment with a new patient at the outset of the therapeutic relationship as part of the informed consent process. Other good practices include making a copy of the patient’s insurance card for your records and contacting the insurance company to verify coverage as soon as possible. 

Because a patient’s insurance coverage can change anytime during the year, psychologists should regularly check to make sure that patients still have insurance coverage and that their benefits have not changed. It is equally important to document in your file your periodic efforts to verify a patient’s coverage and any communications with the insurance company.

You should know insurance information for all your patients — even those who self-pay. It is critical for you to know if a patient has coverage with an insurance company with which you are contracted as an in-network provider. Generally, managed care contracts prohibit providers from charging insureds more or less than allowed under the managed care fee schedule. 

In summary, it is important to discuss and confirm insurance coverage with all of your patients regularly.