Health insurance can be a complicated and frustrating thing to deal with. Too often, there seems to be a gap in understanding between healthcare employees who work in different areas of healthcare. For example, a pharmacy technician might be savvier on a particular aspect of healthcare insurance than a nurse, or vice-versa. This gap in understanding healthcare insurance can make it harder for different healthcare professionals to communicate with one another. This might cause delays and potential errors in patient documentation. Three of the most important areas of healthcare insurance that healthcare professionals may misunderstand are: deductibles, prior authorizations, and HSA cards.
A deductible is the amount of money a patient, or the insured, will pay before their insurance begins to pick up the cost. The amount varies among plans. Some patients will have a separate deductible for their prescription drugs. Insurance plans with a lower monthly premium typically have a higher deductible that will need to be met. Family plans will often have both individual and family deductibles. The important thing to remember is that all insurance plans are not alike. With so many variables in place, always have your patients contact their insurance company so that they understand what their insurance will cover, especially if they need to undergo a major procedure, such as a surgery for example, or a procedure that involves a hospital stay.
Occasionally, an insurance company will require prior authorization before they agree to pay for a specific prescription, surgical procedure, radiology scan, or lab test, for example. There are several reasons why. If it is a medical procedure, they may view the procedure as not being medically necessary or repetitive. If it is a prescription, there may be a less expensive generic alternative drug that the doctor could prescribe, and the insurance company may choose to cover the generic alternative rather than the brand name of the same medication. If a patient is having multiple scans or tests done, an authorization might be required to ensure that the tests are not duplicates, and the facility is not billing for tests that have already been performed at a previous visit. Most pharmacies and facilities send a prior authorization request to the doctor automatically. Because of this, the patient needs to have a clear understanding of how the doctor’s office handles administrative procedures pertaining to prior authorizations.
These days, many insurance policies come with an HSA (Health Savings Account). Such accounts come with a pool of money that can be used for medical expenses such as appointment copays, prescriptions, and procedures. They are a great resource, especially when the patient needs to pay an unexpected medical bill. This can also help the patient offset the costs incurred with a high deductible. Depending on the insurance plan, the HSA funds may expire or roll over. They also offer a number of tax benefits, making them an attractive alternative that many patients might consider when signing up for an insurance plan.
To work effectively in the field of healthcare, you must understand how insurance works, and the role that insurance plays in the care of your patients. This will give you an advantage when helping your patients, and it will make the billing and payment process easier for both yourself and your patients. Patient care is one of the most important aspects of healthcare and a little extra knowledge, especially about insurance processes and procedures, can go a long way.