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Discussion

Question for those who work in clinics

I'm just curious what your clinic policy is on putting insurance information in the paperwork that the doctor gets prior to or during each visit. The type of insurance a patient has, has always seemed to me to be irrelevant to the nature of the visit. Do patients with better insurance then get better care by the doctor? Why does (s)he need to know the status of the patient's insurance while rendering care?

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The type of insurance one has often drives how one receives followup care post office or clinic visit.

1. Preauthorization needed for

a. some lab work

b. radiology/medical imaging test

c. most surgery

d. Home Health Care

e. Durable Medical Equipment (DME)over $250 -$500 (depending on insurance plan) ---some

insurances have NO coverage for hospital bed, wheelchair, Oxygen, wound care supplies, prosthetics, etc.

f. Home IV therapy

g. Hospitalization

h. Skilled Nursing Facility or Rehab admission

i. outpatient Physical Therapy

j. medications aand chemotherapy

2. Capitation (must use this business for ) --especially if HMO plan

a. lab for bloodwork (Quest, Labcorp, hosptial lab)

b. Physician network/specialist

c. Radiology provider

d. Podiatirst

e. outpatient Physical Therapy provider

f. Medical Equipment Company

g. Prosthetics provider

h. Hospital

3. Medication Formulary

What is covered under insurance plan or even if patient has medication coverage

These are the big items I deal with every day as Central Intake Manager in Home Healthcare agency

.... and queen of authorizations. :)

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