Web published 1/1/2002

Not too long ago, patients had to file their own insurance claim. Today, with a focus on customer service, the doctor''s office staff takes care of this burden for the patient. Below is a list of ways you can help your doctor''s staff make sure your insurance claim gets paid within an acceptable time frame. Hopefully, we have given you some useful suggestions for your next doctor''s appointment.

Provide accurate insurance information at check-in rather than relying on the front desk staff to ask you if you have a new insurance card. Always destroy your old cards.

Let the staff know if you have a new primary care physician. As specialists, we send information relating to your care to this doctor as to provide continuity to your overall healthcare.

Let the staff know if you have had a change of address. Incorrect demographic information will prevent correspondence, including insurance information, from reaching you in a timely manner.

Know the basics of your plan. Today there are MANY different plans available to suit your individual needs. It is impossible for the doctor''s office to keep track of every patient''s plan. You choose your plan; therefore, you should know what you are paying premiums for each month.

Are you involved in an HMO? If so, you must be aware of all their requirements before you see a doctor. HMO''s have many rules regarding referrals and testing. Be certain the physician you see (or have been referred to) is in the HMO network of physicians. Be very careful and know your HMO. A small oversight could prove to be very expensive.

Know your insurance plan''s network. You should be aware of the physicians, hospitals, lab facilities, and hospitals in your network.

Know your co-payments and deductibles—you are expected to pay these at the time of your visit. Insurance companies require co-payments so they can offer cheaper premiums to patients and to make the patient think twice before going to the doctor unnecessarily.

For our Medicare patients, understand your annual deductible. Each year Medicare recipients must pay a $100 deductible. Some secondary insurance plans pay this deductible for you, but do not assume yours does. Check with your secondary plan before the beginning of the year to know for sure it covers your deductible. Also, Medicare pays for "screening" procedures and laboratory work one time in a twelve-month period. For our male patients who get their PSA level checked once a year, make sure you wait at least 12 months before you have the test again or Medicare will not pay for it and you will be responsible for the bill.

In general, anyone who pays for insurance or has an employer that pays your premium for you should be educated about their benefits. Always review statements from your doctor''s office and explanation of benefits from your insurance company. If one of your claims has not been paid, call your insurance company to check the status of that claim. By law, insurance companies must pay a claim within 30 to 45 days and if not the doctor can bill you for the service you received. Please don''t wait until you get a collection letter from your doctor''s office before you get involved. By then, the doctor expects payment immediately.

We do not want any of our patients to feel caught in the middle of their healthcare and their insurance company so educate yourself, ask for help and be proactive in your healthcare.