Most of my info re insurance companies is from http://www.healthleaders.com
web site. It is a free site for the first year, Look under managed care on this site.
What insurers are big in your area, and I'll keep them in mind.
I keep up with insurance changes to advocate for clients as intake RN. We are responsible for verifying eligibility and obtaining initial authorization for home care; knowing which insurances we have active contracts with and which companies are still in business! We cover PA, NJ and north Delaware processing approximately 800 new referrals each month.
Additionally, per JCAHO standards we are requiried to verify that ALL doctors licences are current, not expired and now we even have to check that no MC sanctions are imposed BEFORE we admit a client. New Jersey does a good job getting this info out to home care agencies. PA is 1 year behind. One of our agencies had to payback MC funds as DR had sanctions against him, unknown to us. Thankfully, we have a entry clerk that does this. I assist by getting new Docs license, UPIN #s, mailing address and correct phone #'s if I don't recognize a name. We developed an insurance verification specialist clerk position who does much of this checking, with myself and supervisor as final troubleshooters. Since I oriented Maria last August, our rate of problem insurance claims is less than 2% since insurance verification is done prior to admission and way before billing.
It's suprising how many persons don't know what insurance they have or that their policies are not in effect. I aggressively followup all cold calls from people calling re " I need a nurse, I'm sick". Today, i advocated for a 90 YO woman who fell 10 days ago and fractured left leg, casted 10 days ago; NO homecare arranged. Today she fell again trying to get out of chair and
fractured right arm, seen by orthopod and sent home---again NO home care....took 20 min for dtr to get story out, contacted PCP, of course away for 10 days, DTR doesn't kjnow orthopod's name cause brother took mom to Drs. Thankfully PCP nurse stated doc will sign plan of treatment on return and agreed to RN, and PT with eval for OT, HHA and MSW---pt totally independent before fall now incontinent, no wonder!