When an insurance company states that the patient is "Covered" this does not mean that the patient will be covered or "paid in full". What "covered" means is that the insurance company will take a look at the claim you submitted and determine from the patients benefits, per their specific plan, if the claim will pay in full or if the patients deductible/coinsurance/copay will apply. Covered means your claim will get processed, and if the claim processes towards the patients deductible then this is considered a "covered" service in the insurance language.
Also, you always want to be on point with the insurance companies. You cannot rely on your patients to verify benefits. Your patients have no idea what to ask, let alone, even want to bother with the insurance.
P.S. The patients want to deal with the insurance company just as much as you want to deal with the insurance company. Not FUN. Plus they have no idea what to ask, or where to even begin.
However, if you insist on the patient verifying their benefits then create a compliance plan that includes a form/guideline that helps the patient find out what to ask. The insurance companies are going to always tell the patient what they want to hear, which is "this is a covered benefit". BOOM! instant "Yay" my insurance will pay my claim, in full. WRONG, Sorry to burst your bubble, but again, this means, it’s a covered benefit, meaning the claim will process and could go towards deductible/coinsurance/ copay.
