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Pre-Determinations

Advantages: Everyone knows the score. Committed patients will still do the work even if denied. This weeds out the "shoppers."

Disadvantages: If they have to wait, many patients will never schedule.

 

Recommendations: 

1. Thoroughly educate patients on the insurance game, including what a Pre-D is. While most Pre-Ds are paid they are not a final determination of coverage. Patients must understand they are ultimately responsible.
2. In Network: Pre-D when it can be done instantly, which is now the case with many providers.
3. In Network: If you can't Pre-D instantly but the patient still wants one, 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. If they are denied, their anger will be directed at the insurance company, not you or your staff.

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Transforming Practices Since 1996

 

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