As a PT, understanding how health insurance works can sometimes be an unpleasant yet important part of the profession. Of course, treating patients is our primary role but since we spend so much time with our patients, taking an opportunity to educate them about their insurance can set us apart from other health care professionals. I recommend a bit of research about the insurances you deal with most and a good place to start is on the APTA website.
In my experience there are a few key things that we as PTs should know about insurance:
1) Understanding the insurance verification
2) What is the patients responsibility
3) What is your responsibility as the PT
Once a patient attempts to schedule an appointment for PT, most PT clinics have an administrative staff member perform an insurance verification. I think all PT’s should do a few just for the experience. If you have never done an insurance verification before, its very simple and usually is best done with a phone call to the insurance company. Once the patient provides you with their information, call the insurance company to speak to a representative.
The rep will tell you about the co-payment, co-insurance, deductible and maximum out of pocket costs. Do a web search for these terms or read something like this so that you know the difference. The rep will also tell you if the patient needs authorization, how many visits they get and if there are special forms that need to be filled out. Try to get a good understanding of what needs to be done so that you know what the patient needs to do and what things you need to do.
The PT may need to send in their initial evaluation, progress notes or fill out specific forms in order to get visits. PTs may need to track visits so that they know when to submit information to the insurance company. A good EMR, such as WebPT, provides tools with alerts to help you do this.
All of this is done following HIPAA guidelines and should not direct your treatment. Look at it as a learning experience and something that builds your knowledge in an industry that is complex and changing. If we as PTs know these things about insurance we are better prepared clinicians. If we can explain these things to the patient we are not only health care providers, but also health care resources.