Nurses collecting copays

Originally posted by Rapheal

What next, calling the insurance company and verifying their coverage?

That is part of my our job description working as Central Intake RN's in a homecare agency.

Unless you've worked in homecare, you wouldn't believe the amount of patients that have NO IDEA that they have changed insurances! They get approached at a clinic, medical assistance, doctor's office or senior citizen meeting and are informed about this glowing company that can get them eyeglass coverge or "supplement to Medicare". They sign on the line not realizing this is a managed care company and that they have to get authoriztions and their dear Medicare or Medicaid is no longer primary.

Once a policy is changed it may take up to TWO MONTHS to appear cancelled by prior insurance. Prior insurance has given you auth, you provided SN, PT even many services only to find out weeks later that the patient was termed one month prior!!!

I have a great insurance verification clerk who does most of the work after RN's gather info but if any questions referrals get brought to me. I am the final say at my agency as to which insurance is primary as I'm the only one most times able to ferret out the intricicies of policies.

Re Copays.

Aetna Golden MEdicare started copays for homecare January 1st, 2003----homecare NEVER had copays in the past. Charge is $20.00 per service/per visit/per day. So if you had a CVA and needed SN, PT, OT, ST and HHA and they all visited the same day that copay would be $100.00 just for ONE DAY of service. Since services occur 2-3 times a week copays would be $300.00/week for this patient; usualy 6-8 week homecare period, Total cost in copays: $2,400! How many patients can afford that??? The RN's I work with think this insurance company did it as a way OUT of eEdicare HMO business. Yet same week full page newspaper ad touting this product.

The Aetna eligibility clerks can't even accurately tell me the first time if patient has copays either....might take 2-3 calls and 20 minutes of my day PER patient referral (when it used to take 1-2 minutes to verify eligibility). THen I call the patint to notify them of copay and bill to be sent.

Our "competittion" first tried to have their RN's get copay at the door; staff balked due to safety issue of requesting and carrying money. So what did they decide? STOP ACCEPTING COPAY PATIENTS! So now I'm getting twice the referrals for Aetna Medicare. Now, word has gotten out that were accepting these patients. Most agency's in my area can't afford to take such a financial loss (if they can't get pt. to pay copay) so are referring to US!

Please, when chosing insurance, read the fine print, check out homecare and DME (durable medical equipment coverage) you just might be surprised to find it isn't covered or has high copays. One surgical or minor illness can wipe out your savings. Please don't make the mistake my neighbor did: droping Medicare part B as never used it--one month later wife had CVA and he lost ALL his savings to pay for care.