Are you ready for 2017?
If you have been through a transition into a new year as a provider working with insurance, you know that January brings its own special chaos. You don’t know how many of your current families will have changes to their insurance on January 1st, and new clients are calling because they are gaining coverage for the first time. Insurance companies will not give you answers until after the first of the year and even then, you often hear, “call back when the new benefits are loaded.” Wait times seem to stretch on for hours and getting an authorization becomes a marathon. While getting through January will always come with a few bumps and bruises, you can take some steps to make it a little less hectic.
Start by checking in with families ahead of time.
Get in the habit of asking parents about insurance changes every December, and if you’re really on top of it, ask in June too! Most insurance policies reset on January 1st, followed by some renewing on July 1st. Even if families do not have new insurance cards yet, you can prompt them to get new information to you right away. This way you will be prepared for the number of clients that will be going through changes.
Once you have identified which clients will be changing insurance policies, discuss with your families the implications the changes could bring.
Remind them that you will verify ABA coverage on the new policy, and ask if they have verified coverage. Many families who have had ABA coverage assume a new plan will also have coverage without realizing that an employer could change to a policy that does not cover services. In addition to verifying benefits, you will likely have to go through the authorization process. If a client is already in services, you can ask for the same level of continued services with the new insurance. However, keep in mind that the same number of hours in the authorization is not certain. Get over this hurdle by assuring families that you will follow up with insurance as quickly as possible and will communicate any updates or changes with them.
Remember to prepare your staff.
Your administrative team may need some extra hands to get through calls on new insurance plans. Hold times are longer, and you may even have an influx of new clients to get through the process as well. Clinicians should be prepared to have updated treatment plans ready for any clients who have alerted you to pending insurance changes. You will need these ready for authorization requests.
Finally, keep in touch with your insurance company.
Make friends with your provider representative and ask if any pending changes are coming for ABA providers. Some insurance companies release newsletters or have ABA specific pages on their websites. Be sure you keep demographic information up to date with the insurance companies the you are in network with so you receive any notifications of changes via mail or email. Examples of changes that may occur at the start of a new year might be new or different authorization requirements or the addition of HMO networks.
You will not be able to act on the changes until January so it’s not too late to ask parents if any insurance changes are coming. Send a flyer out with your clinicians, dust off that parent email list, or ask as kids get dropped off at center based programs. Even if you have not started preparing for January, you still have a few weeks to get ready!
If you need more help in preparing for the coming new year, contact us today at (520) 800-4740 or shoot us an email! We are here to help.
