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Predeterminations

Predeterminations

Advantages to submitting a predetermination: Everyone knows the score. Committed patients will still do the work if denied.  You weed out the "shoppers".

Disadvantages to submitting a pre-d: Many patients, if they have to wait, will never schedule. 

Recommendations: 

1. Thoroughly educate the patient on the insurance game including what a pre-d is and that while most pre-ds are paid they are not a final determination of coverage. The patient must understand they are ultimately responsible. 

2. Pre-d when it can be done instantly which is now the case with many providers. 

3. If you can't pre-d instantly, but the patient still wants a pre-d, go ahead and schedule the patient with enough time to get the pre-d back. Give the best estimate you can. You can always call the patient before the appointment if the estimate is way off. In fact, estimating high is the smart move. 

4. Out of Network/Assignment of Benefits: Always get a pre-d

Doing the above gets patients scheduled while they are in the practice but if they are denied, their anger will be directed at the insurance company; not you or your staff. 

No Show and Cancellation
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