There are certain items that are mandatory when you call a patient’s insurance company. Such requirements are dictated by the Data Protection Act and, put simply, it’s highly unlikely without the right information you can make an enquiry regarding a patient.
The essentials
In the ideal world, you will have:
The Policy Number
Patients name
Patient’s FULL address
The POST CODE (don’t forget it)
Patient’s Date of Birth
Treatment date
CCSD code
The pre-authorisation number is very useful too.
But what do you do if you don’t have the policy number? If you have the patients name, full address (inc the postcode!!) and date of birth you stand an extremely high chance of the insurance company telling you the policy number. Indeed often I’ve had to speak with an insurance company to obtain the policy number.
With the above to hand, it’s not an issue. Use the opportunity to confirm or obtain the pre-authorisation reference as well though.
On a parallel note, some insurance companies will only let you raise three queries per phone call with them. Some may, if they are not too busy, do more but generally speaking three is the limit.
This despite what many think, is important for if you have say 12 to do, it’s going to take time. Especially if you are on hold for 10/15 minutes BEFORE you get through to the insurance company.
So, the very best thing to do is to make sure the clinic list has absolutely everything you need in order to invoice correctly. That way, you won’t have to contact the insurance company first. Also of course, if there is an invoice query after you’ve billed the consultation/episode you will have all the data in front of you when you DO speak to the insurance company.
Without it, you will struggle.