Making things easier for the doctors and insurances

A few years ago, my co-worker hung her head in frustration.
I looked over and asked what was wrong, seeing my co-worker was clearly distressed.
“ I can’t get this lady’s insurance verified! They’re claiming she’s not a US citizen even though she was born in Arizona!” she started to cry.
I asked her to hand me the verification form she was looking at. She did. I quickly saw the problem. Arizona had become the 48th state of the United States on February 14th 1912. The patient had actually been born in 1910, two years BEFORE Arizona became the 48th state. She was actually older than the state of Arizona. I quickly explained that to the insurance, they erroneously thought she wasn’t a US citizen, even though before becoming a state, Arizona was considered part of the USA as a US territory, not Mexico territory. So in fact the insurance had it wrong. We went to look for the doctor and showed him what we had discovered. He quickly got on the phone with the representative for the insurance and quickly pointed out that the insurance was wrong in its thinking and to correct the error immediately because we had a surgical claim to send out. He also pointed out the lady held a Medicare card in her possession, so at some point she had proved she was a US citizen even though she was actually 2 years older than the state she lived in.
So even though you aren’t older than a state, how can YOU make sure things go smoothly for not only the doctor’s office, for your insurance as well?
Here’s a few tips:
Make sure your birth date is correct in the system! Believe it or not, if people can’t read your writing on the forms, sometimes your date of birth can be input wrong. Sometimes it takes the doctor’s office trying to verify your insurance before your appointment when the mistake pops up. And no, contrary to popular belief, we in the billing office can’t change it for you. That’s your lovely thing to fix. Since the insurance won’t hear it from us in the office, they MUST listen to you. Each insurance has its procedures on what they need to get the date of birth corrected in the system. I’ve seen dates off by 5–7 years, making you older or younger than your real age. It’s been very enlightening to say the least.
If you have more than one insurance card, make sure all the cards match EXACTLY. I’ve seen all sorts of stuff when I’ve helped put in information. I realize people like using the nickname on the insurance card, I get it, I truly do. Unfortunately for Insurances, you need to use your legal name for people to find you in the system. When the cards don’t match, it makes it really hard for the insurances to find you in the different systems. Medicare for one, is EXTREMELY picky on this one. If for the guys you are a Jr, a III or IV or VIII, it needs to be on the card or else the system is going to tell us you don’t exist to them, and that’s creating more problems than it helps. Same with hyphenated names. If your name is hyphenated and it’s not on the card, they won’t be able to tell us anything for the billing side at the doctor’s office.
++++++++++++++++++++++++++++++++++++++++
Fun fact: The longest name I ever saw was 26 letters, and that was all they could fit on the insurance card. The patient’s name was actually much longer than that! I had him write it out, and I later counted it, it had 38 letters. I didn’t even try to pronounce it. I just called him by the nickname he wanted to be called by. I can only imagine what the people processing the claims thought when they saw it!
++++++++++++++++++++++++++++++++++++++++
Hyphenated names are more common now than they used to be. If it’s hyphenated on the insurance card, we aren’t gonna be able to find you when we need to call and verify your insurance before your appointment. I worked in an office where we literally tried 7 times to get this lady’s insurance verified. The billing manager ended up having to call her and explained until we had her insurance verified, we couldn’t make the appointment. We needed to see the actual insurance card. The lady reluctantly came in with the card, and only then did we find out on her Medicare card, her name was hyphenated. All we had on the form was her current last name. None of us had any idea she had a hyphenated name, it had never come up. Once the lady understood why we had so much trouble trying to get her insurance because we didn’t know on the card her name was hyphenated, she was A LOT nicer, because she was shooting lightning bolts at us with her eyes until she realized she had caused the problem, it wasn’t the office being difficult and not wanting to verify her insurance. Once we knew her name was hyphenated, it made it much easier to verify she in fact had Medicare insurance.
If you have a common name, but with a different spelling, let them know. Sometimes over the phone, the person will hear Jay when it’s actually spelled Jai, or Kelly and you spell it Kehle, Kellie or Keli. When I took names while on the phone, If it was a common name, I’d ask if the name was spelled the traditional way, or differently. When your name is spelled wrong in the system, it creates problems on the other side at the insurance because they spelling of your name doesn’t match, and it will kick out the claim with a denial.
If you have an unusual name, or your name has silent letters in it, please spell it. It makes it much easier on the office than having the patient screaming at us because we spelled your name wrong. If we have it wrong in the system, you better believe when we send the claim out to be paid by your insurance, it’s spelled wrong on the claim. Better to correct us when we first put it in the system to avoid problems down the line when the insurance kicks back the claim with a denial because your name doesn’t match the insurance system.
When we ask you, the parent for your information instead of your child’s, please realize by law we can’t ask for the child’s social security number. I’ve been blasted by so many parents before they saw the printout of the law stating we can’t ask for children’s social security number. It’s to protect them, the child, from identity theft. It’s not like we’re going to send you straight to collections…..so please don’t kill the messenger when they ask for the parent’s info. We are just trying to follow policy.