The Insurance card, the newest one, that can be read

I am trying to keep this relevant to real estate, but the reason I even thought about doing this blog was because on the BP Money Show they keep saying ‘Would like a show about health insurance’.

My job was to work accounts that did not have insurance. I would enroll people into Medicaid, find the insurance they ‘think they might have’, or talk to them about options for charity. I also did insurance verification/clearance and I would provide estimates for facility (hospital) charges for procedures. In the ER I also was exposed to the odd insurance things like workers comp falling under the Jones Act or Medi-share programs because these odd health benefits schemes would fail the automated systems and come back to my groups desk as no insurance.

I would like to take the time to talk in this blog post about the INSURANCE CARD!!!!!!

Yes, I am yelling. Why, because it is frustrating and costly to not have the most recent card and in a format that can be read.

The insurance card provides a lot of key information that you don’t even realize matters. It will provide: Your name, ID number and prefix, Group, Carrier, Plan, 800 number for customer service, billing address, notification phone number or fax, benefits number and possibly even more phone numbers.

Lets start with the first one – your name. Your medical record number at your facility or DR’s office will most likely use your legal name as it appears on an official picture ID, most likely your State ID/Drivers license card. You may have had your insurance since before you got married. You may have never even bothered to change the last name with the insurance company. You have gone by Ted so long you have forgotten you drivers license says Theodore. You may be Henry William III, but the insurance carrier has just Henry William. When we try to verify the information, it fails or rejects. You sign in to the ED greeter desk and collapse on the floor unconscious, you wrote Ted Smith and your medical record with all your allergies is under Theodore Smith. Getting the picture yet.

The ID number is next. I can look at an ID number and tell you what number I am most likely to call on 75% of the ID numbers I am presented with. These ID numbers change, so this skill will wane for me as I am not working in the healthcare industry at the moment and being exposed to these all day. It is important to get the newest card and have that. You will receive it around the first of the year and it will be sent to the address listed with HR or your carrier. If the plan changes, maybe the number doesn’t, but the prefix changed for the new year. That authorization for service obtained in December might be null and void because we got it using your old Prefix and ID number. This could delay a procedure for upwards of a month or two in worst case scenarios. Group number also fits under this type of error that could cost you money.

Carrier might not be what it was. The Insurance carrier can change and there can even be wild differences in what the carrier has available in the area. We had a health insurance company called Group Health in Washington state that was bought by Kaiser Permanente. KPS was a plan for groups on the other side of the sound that folded their health insurance plans into Group health. It gets messy.

KP is not KPS. But now both are under the same umbrella. KP has a Washington state plan and several other plans throughout the US. Someone comes in and says they don’t have a card, but the have Kaiser. But we can’t find the plan running Kaiser of Washington. Even our Seattle Kaiser customer service can’t find the patient. If the card starts with a 5 for the ID number, I know (after several failed searches in the past) that is going to be Kaiser Northwest Region out of Oregon and not Kaiser Washington state. Kaiser Hawaii is an HMO and very strict. We admitted someone and they didn’t have their card and didn’t know their insurance. 3 days later we found they had Kaiser of Hawaii. Since we didn’t notify the local Kaiser group, the patient was stuck with an out of network bill at 50% cost share instead of 10% cost share. If we would have notified Kaiser, they would have told us to call the local Kaiser affiliate hospital for authorization to keep the patient or send them to a Kaiser facility to obtain care at the highest network benefit covered level.

Which brings us to the 800 numbers. The 800 numbers can not be obtained online most of the time. The Blue Line – for Blue Cross – requires a prefix to send the insurance verification specialist working on your case to the right carrier affiliate. And the number for benefits could be completely different then the number for authorizations and notifications. Also, they may require certain procedures to use a clearing house that specializes in reviewing certain types of cases. A lot of the time all this information is on the back of your card and significantly reduces the errors in contacting the right group to obtain authorization to get you the greatest bang for your insurance dollars.

You have no idea what I can tell glancing at your card, but if you present me with the wrong one/none, it delays care that can be delayed or leaves you with a potential bill that you would not have had if your insurance card was the newest and readable.

Make a copy of the cards, date the copy. And if you are taking care of parents or family members or are guardian for someone – keep a copy of their card(s) also. A fax or email of a card can relieve a lot of stress. Try to review them yearly, and make sure you have the most current ones. You may want to keep copies of last years card because it can take upwards of a year to complete the billing process on more complex cases or appeals processes that you may not even know are going on in the back ground as billing is working your visit.

I hope you are getting information out of all this. It is super complicated, and I don’t want to give you too much information at once. I also want to make sure it is targeted towards the BP Money or the small business/self employed person making a career out of Real Estate investing.