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.

[Zookeeper3]

When I worked electrophysiology this was vital, we also implanted pacemakers and ICD's. It's part of our screening process. A self pay needs to know that thier A-fib ablation will cost over $90K just for that, anesthesia and the doc charge is seperate. The same is true for our ICD's. The budget only allows for so many indigent cases. A homeless person where I am now has an EF of 10% and needs an ICU, he won't get one without insurance here.

Knowing if and what type of insurance allows us to set the patient up with case management and financial counceling so they can make educated decisions about thier care. This is especially true with new name brand medications, they can be very expensive and less expensive options may work as well.

[TiffyRN, BSN, PhD]

Everybody who has posted after the OP have given legitimate rationale why they look up insurance information. The important thing is that they know the reason.

Not knowing why is like saying to a student that they need to know the normal pH on an ABG is 7.35 to 7.45 and leave it at that. You need to know why.

At my first job I didn't even know how to look that up. It was probably available, don't get me wrong, it just didn't interest me and really had no relevance to that particular job.

[alannah_smth]

I had a patient that paid for a lot of his treatment out of pocket so he was really careful about what he spent. He brought his own bath tub and emesis basin; he even brought his own tissues. If your nurse has had some bad experiences with very involved, frugal patients, she could be concerned about helping people save money. So maybe if they have to pay a lot, she would just use a damp washcloth to clean up a patient and try to save those expensive wipes for emergencies since they are so expensive. Just a thought..the care that you give shouldn't depend on the insurance at all though!

[BluegrassRN]

I would say that most of the nurses I work with don't know or don't care what insurance pts have. I personally look to see if they have insurance, and if they don't, I ask if they have any concerns regarding their hospital bill. We are supposed to ask this upon admission, but I've found it gets skipped.

I think it's important to know whether a pt has insurance. If they don't, or if they are concerned about their deductible, etc, our hospital offers discounts and very reasonable payment plans. If they don't have prescription plans, there are several less expensive options on medications, and physicians and nurses should be aware of this. If they don't have office coverage, we have three great clinics in town; two are low income, and one is a physician's office that works on a unique subscription, cash service and is perfect for those who have no insurance or catastrophic plans but who do not meet the income guidelines at that low income clinics.

Knowing a pt's insurance status is very important at discharge, for their post hospital care. It's also good to know to help address any financial concerns.

Also, some insurance companies have certain lab and pharmacy requirements. If we called in scripts to the wrong pharmacy, the pt was responsible for the entire amount. For outpt labs, if we just sent the pts to our lab instead of the designated outpt lab, again, the pt was responsible for the cost of the labwork.

[Picklefreak]

I had a patient that paid for a lot of his treatment out of pocket so he was really careful about what he spent. He brought his own bath tub and emesis basin; he even brought his own tissues. If your nurse has had some bad experiences with very involved, frugal patients, she could be concerned about helping people save money. So maybe if they have to pay a lot, she would just use a damp washcloth to clean up a patient and try to save those expensive wipes for emergencies since they are so expensive. Just a thought..the care that you give shouldn't depend on the insurance at all though!

I think if this were the case, the OP's preceptor would have explained herself. Her comment of, "you'll figure it out eventually" makes me think she has some preconceived notions about uninsured or Medicaid patients.

[JZ_RN]

Now that I work in primary care, and with mostly uninsured/underinsured/medicaid patients, we have to be very careful what meds and treatments we order and prescribe. They have no money and little to no coverage. We have to be conscious of money. And God knows we don't have time to be doing prior authorizations for every stupid thing all day long.