Why is it important to know patient's insurance info?

[Despareux]

One of my preceptors told me she looks up insurance information for every one of her patients. She didn't explain why, but told me I would figure it out soon enough.

So what did I miss, because I can't figure out why knowing my patient's insurance information is important.

[Do-over, ASN, RN]

I don't check the chart for insurance info - like others have said: I don't normally care and really don't have the time. Why would I? I don't do billing, and my pay/care doesn't change based on the patient's insurance or lack thereof. If I have time to browse I read the progress notes.

However, I have had many late night discussions with patients re: financial situation and ability to afford medications, exercise equipment, etc. Pradaxa came up the other day - docs wanted the patient to start it but it would cost about $100 a month in co-pays...

[AMN74]

In home health is is VERY important to know your patient insurance info. Some insurances require certain documentation, that others do not. Some insurances cover a limited number of visits while others do not. Some insurances have copays for each visit while others do not. Some insurances cover home health supplies, while others do not. Some insurances provide other benefits that a social worker can help the patient get, while others do not. Of course we see all patients, regardless of their payer source, indigent, medicare, medicaid, managed medicare, private insurances, workers comp etc. It does not stop us from seeing the patient, but we have to know the payer source in order to know what other services they qualify for, to know what kind of documentation is necessary, and to get them set up with a DME supply company that will accept their insurance if their insurance does not cover supplies. I never paid attention to what the payer source was when I worked in the hospital, unless I had a question about if the patient would be able to pay for medications upon discharge, or if they were going to be referred to rehab or home health.

[llg, PhD, RN]

However, I have had many late night discussions with patients re: financial situation and ability to afford medications, exercise equipment, etc. Pradaxa came up the other day - docs wanted the patient to start it but it would cost about $100 a month in co-pays...

Exactly. Nurses may not think that all patients should get the same treatment, but in actuality most patients hope that we will consider their copays as we choose which treatment to give. Patients don't want us to choose treatments that will cause them more money than necessary unless absolutely necessary. And they don't want us to waste their money by not being good stewards of their money.

I doubt that's what the OP's preceptor was referring to ... but it is the truth.

[Pixiesmom, BSN, RN]

It has no bearing on the bedside care of the patient for the average nurse unless she is interacting with Case management.

That is what I was thinking. If I have a pt that looks like they will need assistance of any type after d/c I will make sure they are put on the list for case management.

[Despareux]

It's in a large hospital and my preceptor was a general duty nurse. I have asked my other preceptors, who are also general duty, why they would look at a patients insurance, and they just look at me like I'm nuts while asking me why I would do such a thing. Talk about feeling stupid. Who knows, maybe my preceptor disliked me and wanted to make me look like a fool. Eh, you live and learn.

[TiffyRN, BSN, PhD]

It's important to understand why you would need that information. When I worked in adult care, there was almost never a good reason to know the insurance status. It had some mild relevance as the patient neared discharge as some medications are more reasonably priced and can be safely substituted or one nursing home or rehab hospital would accept the patient's insurance vs. another kind of insurance or medicaid/medicare.

Now that I'm in NICU, it has mild relevance, and it's pretty much mostly related to discharge. I need to know if they are medicaid/charity (not my words, it's printed on the form) vs. insurance to fill out the newborn screening (PKU) cards. I ask the parents if they qualify for WIC because WIC has a contract formula brand and we would prefer to switch the infant over before discharge (WIC has different qualifying factors than Medicaid and they don't always go hand-in-hand). We usually require a pediatrician appointment before discharge and if the parent doesn't have one picked out yet, the kind of insurance or medicaid will help us give them the right list of pedi's that are accepting patients, but that is pretty much a discharge planner duty.

You need to get your instructor to explain the rationale for needing to know the patient's insurance status. Without the rationale, you will not know what to do with the patient's insurance information.

[flashpoint]

A long time ago, there were insurance companies that didn't cover certain medications or procedures if they were done or prescribed by a mid-level. I can remember my dad having to jump through hoops to get some blood pressure medication (I don't remember which one) because his insurance didn't cover it unless a physician prescribed it. There were also insurance companies that didn't cover things like pap smears if they were done by a PA.

There are also insurance companies that don't cover transfers to hospitals that are out of their network, even if they are the closest and most appropriate. I used to do some billing for our ambulance service and I spent a lot of time trying to explain why people went to Denver or Cheyenne instead of Omaha.

But on the floor or in the ER, I never paid attention...it didn't matter to me at all.

[Creamsoda, ASN, RN]

Ive never considered that. Like someone else said, it can matter for discharge medications that are $$$ but their insurance or lack there of doesn't change the care that I give. It may influence the MD's choice of treatments at times I'm sure, but as a nurse , no it does not affect me. Why a nurse would make that a priority and look it up, I have no Idea.

[Fiona59]

Our census had a space for health care number. It just shows the province and number. If they the patient has no provincial coverage is from out of country the box is left blank. It just helps us figure out a few things for discharge and if they are homeless stands out for a Social Work referral. If they are Americans we know it's usually a lost cause in getting them to pay the bill.

[LynnLRN]

I need to know for discharge and getting supplies from DMEs and what brand their particular insurance will cover. However, in a previous job I never needed to know their insurance. Care management had to know but again that was for needs after discharge, for instance if they were going to be transferred to rehab will their insurance cover it, or if they were going home on an expensive medication could they afford it. We never use/used it to deny the pt care while inpt.

[JZ_RN]

I never look up insurance info for my patients unless I am going to try to get a consult or therapy or med ordered and want to see if it will even be paid for first, or if the patient says "I'm paying your salary" I will then usually go to see that they are medicare or medicaid, in which case I will then tell them the next time that NO, I am paying for your care, thanks. You don't have a job.

[That Guy, BSN, RN, EMT-B]

99% of the time I dont know and 100% of the time I dont care. I dont base my treatment on whether or not they can pay. Heck we know that a good majority of our FF will never pay their bills.