How to verify a patient’s insurance information is accurate, especially on Christmas Day?

5:30 am in a dark New York City, four days after the winter solstice, I guess Santa is making his final rounds for all the good children but what about all the good doctors?

Would it not be nice if, because it’s Christmas, if the Health Insurance Fairy left a health insurance company’s fee schedule under my pilliow?

Being an out-of-network physician–meaning I have no contractual relationship with any third party insurance companies including Medicaid and Medicare–I am constantly forced to guesstimate what I will be paid for my medical procedures and time.

To make matters worse–as medical schools do not offer any significant classes in medical billing–I am self-taught, having learned the mumbo jumbo language of CPT codes, ICD-10 coes. modifier codes, all sorts of weird numbers and letter that change often that I put on a “1500 claim form” and send in to my patient’s insurance company. (If you don’t know what any of this stuff is and your a doctor considering private practice, start studying my friend or contact me with questions, as if there is anyone reading this?).

Dropping that form in the mail is like a Hail Mary in football, except I will not find out the compensation (if any) for the doctor services provided.

I get back what is called an explanation of benefits (commonly called an EOB) from SOME insurance companies, not all. That is, in the last year, a few insurance companies like BCBS only send paperwork to the patient, not the doctor, so you have no idea if and when you’ve been paid unless you bug the patient to have them check their male and send you the EOB.

A few health insurance companies have even requested a HIPPA medical release for my office to determine claims and eligibility of a patient’s insurance plaa which is obviously ludicrous since the patient is not yet an established patient.

I can rant and rave for a while but this Christmas, my wish, some transparency from the insurance company “Matrix” unless there is a Neo out there?

So how to verify a patient’s insurance information is accurate, especially on Christmas Day? Would anyone reading this care to offer advice (and I know there are some automated systems that provide claims and eligibility but at least 50 percent of the time, in my experience, I need to speak to a human to get answers, yes, a human).

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