Nurses collecting copays

CATHYW · Mar 13, 2003

TOTALLY inappropriate! Let one of the clerks handle that part. That is in no way, shape or form, a nursing duty!

I used to work in an ER that required that we send patients to the registration desk to pick up their scripts and discharge papers after we had gone over them with the pt. The idea was that they'd hold the Rx's "hostage" for co-pays! I didn't like it, a bit!

deespoohbear · Mar 13, 2003

Originally posted by CATHYW
TOTALLY inappropriate! Let one of the clerks handle that part. That is in no way, shape or form, a nursing duty!

I used to work in an ER that required that we send patients to the registration desk to pick up their scripts and discharge papers after we had gone over them with the pt. The idea was that they'd hold the Rx's "hostage" for co-pays! I didn't like it, a bit!

Definitely not a nursing duty. That is why there are admission clerks and receptionists.

Rapheal · Mar 14, 2003

Originally posted by deespoohbear
Definitely not a nursing duty. That is why there are admission clerks and receptionists.

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

Home Health Columnist / Guide · Mar 14, 2003

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.

Rapheal · Mar 15, 2003

NRSKarenRN,

My sympathies. Your plate is very full. I worked in medical billing in which I had 6 hospital accounts in which I attempted to collect fees from insurance companies, victims assistance, Medicare, Medicaid and workers comp., for ED doctors.

It is a very complicated and time consuming process. Many of the elderly as you know are very confused about this process and find out the hard way that they are not covered for many things. They are targeted by some insurance companies who know this and IMHO they are chosen as "prey". Since it is so difficult to figure these policies out, the elderly many times choose to pay the bill, even if it should be covered. And billing services encourage the patients to pay and tell them "you can collect from your insurance later, but if we do not receive payment we will refer you to the collection department. This will affect your credit"

.

And from my experience many insurance company clerks are taught to stall eligibility info and payment. This way the company can hold on to the money longer, gathering interest, or playing with their investments so that they will increase profit or decrease loss. I will add that this has been my experience for SOME companies, because I do not want to make a general statement about all companies and get sued. Well good luck. It is sad that you have to see your patients go through such a mess when they are already ill and stressed out.