Tuesday, February 17, 2015

Why? Why do they do it?

When we get a new patient, we add them in to the computer. We ask for their insurance, and they fork over their card.  

But if the insurance is expired, why do they feel the need to give us the card? Why can't they say, "my insurance is expired," "I'm in-between insurance," or "this is a cash pay"? 

Why do patients feel the need to go ahead and let us spend the time typing it in then let us try to bill it? It costs us money every time we send off an adjudication whether it is a paid claim or not. And it wastes time we could be filling their script or helping other people.

What's worse, a significant number of people will insist that they have coverage even when it comes back as expired or invalid ID or whatever. So we get on the phone, spend countless minutes yelling "PHARMACIST" or "REPRESENTATIVE" to try and get to talk to a live person ONLY to find out that the computer is correct, THEY DON'T HAVE CURRENT COVERAGE.

Why do they do this? Please, explain it to me.


Officer Cynical said...

For the same reason people with no car insurance give me an old card and insist the policy is current when I stop them or they have a crash: they think it will fly. But if I'm suspicious they don't have insurance, I just make a quick call to the agent or company. If it comes back that they have no active policy, I write them the no insurance ticket and impound their car.

Crazy RxMan said...

I get that, but you don't have ten other "speeders" waiting for you to process their ticket. It's rude to me and the other people waiting in line when they know better.

Officer Cynical said...

I guess if you're the sort who knowingly hands over a bogus insurance card in hopes of getting over on somebody, the idea of inconveniencing others never occurs to you.

Loren Pechtel said...

Many doctors offices don't check every visit. Thus getting service on an expired insurance card isn't exactly unheard of. Such people normally don't have assets, the bill from the doctor's office isn't going to do much of anything to them.

The fact that it's not going to work in a case like this probably doesn't sink in.

Anonymous said...

Probably because they don't have the money to pay you. They're hoping you'll let them take the medication, attempt to bill the insurance, and they'll deal with the bill (or not) later on.