As a billing company focused on holistic medicine we speak to hundreds of practitioners on a daily basis so we get a pretty good sense on what the hot button items are within our community. At the beginning of every year most patient’s health insurance benefits are recalculated. That is to say that the number of visits and deductible amounts are re-set on January 1. So a frequently asked question through our provider hotline is “How do I handle a patient’s deductible?
A deductible is an insurance term that refers to the amount patients have to pay out-of-pocket before their insurance benefits will subsidize payment; the amount is identified when verifying insurance benefits. Patients’ deductible is determined by their insurance plan and will range in amount, so you will not know the exact balance until you verify the insurance benefits.
Insurance verification is a critical component of billing insurance for acupuncture and other holistic services. In our opinion, correct verifications have the most direct correlation with successfully getting claims paid.
When your client has an unmet deductible, make them aware of the amount, you will then typically charge the patient a fee at the time of service. You must bill the insurance claim as you normally would to satisfy the deductible. The insurer will process the claim towards the deductible at the allowed rate. Once the patient’s deductible has been met, the insurance will begin to reimburse the treatments.
Here is an example of a payment schedule for a patient approved for 15 visits with a $500 deductible and a $10 co-pay. In this example the insurace plan pays $100 per visit.
It’s important to pay special attention to deductibles the first couple of months of the year, however, not all plans go by calendar year; some “contract year” plans use deductibles that are recalculated on a date other than January 1.
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