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Insurance - Everything You Need to Know
Navigating your insurance for bariatric surgery can be a challenge. Allison Lorenzo and Denise Ortega, medical billers, discuss how insurance works for bariatric benefits.
Featuring:
Allison Lorenzo is a Medical Biller.
Denise Ortega | Allison Lorenzo
Denise Ortega is a Medical Biller.Allison Lorenzo is a Medical Biller.
Transcription:
Bill Klaproth (Host): The complexities of health insurance benefits can be stressful. But the billing department at Garden State Bariatrics and Wellness Center is your advocate, your partner and your champion. So, let’s talk about insurance and everything you need to know with Allison Lorenzo and Denise Ortega, Medical Billers at Garden State Bariatrics and Wellness Center.
Ladies, thank you for joining me. Allison, let’s start with you. So, what is the first step when it comes to verifying insurance?
Allison Lorenzo (Guest): First thing we do when a patient calls in is, we contact the insurance. We obtain their insurance information, ID number, all of those. All of that information. We call the insurance to confirm that yes, the policy is active, that yes, it does carry out of network benefits since we are non-contracted providers. And yes, that it does have bariatric benefits. We have to specifically inquire that or else the services will not be covered. And we determine all of this before we even schedule the patient so that way they are not surprised or held up at the time of their first appointment.
Host: So, Denise, Allison just talked about out of network bariatric benefits. Can you explain those to us and what insurance plans you do accept?
Denise Ortega (Guest): Because we are out of network, some insurances don’t allow you to see a doctor that is out of network. So, that’s when she had said we have to confirm and make sure that first off, you have those benefits available. We don’t accept HMO plans or anything that has to do Medicaid, because they don’t allow the patient to see an out of network provider. Other than that, we do accept most plans and we work with a lot of the plans as long as you have the out of network coverage.
Host: And Allison, you also mentioned no surprise billing. Can you explain that to us?
Allison: Certainly. Well, what that means is as nonparticipating providers, we are not directly contracted with any insurance. That means we don’t have a set reimbursement rate for the procedures. So, what we do for the member is we determine what their benefits will cover, what their insurance plan will cover, at what rate and we tell the member, we detail that out, letting them know this is what it covers, this is what they say you should be responsible for. But being that we are not contracted, we have the liberty to fine tune what the patient responsibility is. We make that patient specific depending on what their current life limitations, finances, all of that is. And if they can’t afford these currently high deductible plans for example; we work it out case by case per member what they can afford and what they cannot afford. And we put that all down on paper so that way down the road through the process, they know what they are getting a bill for and when they start seeing this paperwork from the insurance saying what they should be responsible for; they know that we will not hold them responsible for that. We work with them directly case by case.
Host: Well that leads me right to my next question. Denise when we say our billing department is your advocate, your partner and your champion; what does that mean? Is that due to the individual attention that Allison was just talking about?
Denise: Yes. Absolutely. The best thing and great thing about my job is that I really like to get to know the patient, get to meet them, bond with them, make them feel as comfortable as possible and letting them know that we are a 5-Star and we are here for them. We guide them through everything and we try to just have them focus on getting the health and the care that they need here in the office with all the great doctors that we have here. And we try to just have them focus on that and not worry too much about the financial need. As Allison had just stated, we work with them and we have many affordable payment plans that we offer the patient just to try to make everything go smooth.
Host: Well that individual attention is so important, and it definitely shows. So, Allison, I’m sure that you and Denise get questions all day long. Can you share with us some of the questions that you often get asked?
Allison: Well number one question is what is this going to cost me. Is my insurance going to cover this? And as we stated before, before the member comes in to the office; we try to obtain that information from their insurance carrier up front. Specifically, are the procedures covered? At what reimbursement rate like if the policy has a deductible, what co-insurance, what are non-covered charges. We try to detail all of that up front so when they come in and throughout the process; we let them know. If things are not covered; we advocate on their behalf. We appeal with the insurance. We fight with them directly, so the member doesn’t have to have that hassle and that burden on them. We try to get everything covered for them. And ultimately, if we are unable, if we fail in getting a charge covered; we don’t put that balance, that responsibility on the member. We write those things off. We take care of it in house.
Host: Well I love how you advocate for the patient. So, Denise, as we wrap up, what else should we know about the insurance process?
Denise: Pretty much Allison had covered as well, the insurance could be something that could be stressful but that’s our job. So, mainly our goal is so the patient doesn’t have to get involved. So, we just try to make it as easy as possible and stress-free for them and we want the patient to be excited and being happy with the care that are receiving her in the office.
Host: Well Allison and Denise, this has been great. Thank you so much for your time and talking to us about the insurance process.
Denise: All right, thank you so much.
Allison: Thank you Bill. It’s been a pleasure speaking with you and everyone in the audience today.
Host: And for more information, please visit the Garden State Bariatrics and Wellness website at www.gsbwc.com, that’s www.gsbwc.com. And if you found this podcast helpful; please share it on your social channels and check out the full podcast library for topics of interest to you. This is Winning Through Losing, a weightloss surgery podcast with Garden State Bariatrics. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): The complexities of health insurance benefits can be stressful. But the billing department at Garden State Bariatrics and Wellness Center is your advocate, your partner and your champion. So, let’s talk about insurance and everything you need to know with Allison Lorenzo and Denise Ortega, Medical Billers at Garden State Bariatrics and Wellness Center.
Ladies, thank you for joining me. Allison, let’s start with you. So, what is the first step when it comes to verifying insurance?
Allison Lorenzo (Guest): First thing we do when a patient calls in is, we contact the insurance. We obtain their insurance information, ID number, all of those. All of that information. We call the insurance to confirm that yes, the policy is active, that yes, it does carry out of network benefits since we are non-contracted providers. And yes, that it does have bariatric benefits. We have to specifically inquire that or else the services will not be covered. And we determine all of this before we even schedule the patient so that way they are not surprised or held up at the time of their first appointment.
Host: So, Denise, Allison just talked about out of network bariatric benefits. Can you explain those to us and what insurance plans you do accept?
Denise Ortega (Guest): Because we are out of network, some insurances don’t allow you to see a doctor that is out of network. So, that’s when she had said we have to confirm and make sure that first off, you have those benefits available. We don’t accept HMO plans or anything that has to do Medicaid, because they don’t allow the patient to see an out of network provider. Other than that, we do accept most plans and we work with a lot of the plans as long as you have the out of network coverage.
Host: And Allison, you also mentioned no surprise billing. Can you explain that to us?
Allison: Certainly. Well, what that means is as nonparticipating providers, we are not directly contracted with any insurance. That means we don’t have a set reimbursement rate for the procedures. So, what we do for the member is we determine what their benefits will cover, what their insurance plan will cover, at what rate and we tell the member, we detail that out, letting them know this is what it covers, this is what they say you should be responsible for. But being that we are not contracted, we have the liberty to fine tune what the patient responsibility is. We make that patient specific depending on what their current life limitations, finances, all of that is. And if they can’t afford these currently high deductible plans for example; we work it out case by case per member what they can afford and what they cannot afford. And we put that all down on paper so that way down the road through the process, they know what they are getting a bill for and when they start seeing this paperwork from the insurance saying what they should be responsible for; they know that we will not hold them responsible for that. We work with them directly case by case.
Host: Well that leads me right to my next question. Denise when we say our billing department is your advocate, your partner and your champion; what does that mean? Is that due to the individual attention that Allison was just talking about?
Denise: Yes. Absolutely. The best thing and great thing about my job is that I really like to get to know the patient, get to meet them, bond with them, make them feel as comfortable as possible and letting them know that we are a 5-Star and we are here for them. We guide them through everything and we try to just have them focus on getting the health and the care that they need here in the office with all the great doctors that we have here. And we try to just have them focus on that and not worry too much about the financial need. As Allison had just stated, we work with them and we have many affordable payment plans that we offer the patient just to try to make everything go smooth.
Host: Well that individual attention is so important, and it definitely shows. So, Allison, I’m sure that you and Denise get questions all day long. Can you share with us some of the questions that you often get asked?
Allison: Well number one question is what is this going to cost me. Is my insurance going to cover this? And as we stated before, before the member comes in to the office; we try to obtain that information from their insurance carrier up front. Specifically, are the procedures covered? At what reimbursement rate like if the policy has a deductible, what co-insurance, what are non-covered charges. We try to detail all of that up front so when they come in and throughout the process; we let them know. If things are not covered; we advocate on their behalf. We appeal with the insurance. We fight with them directly, so the member doesn’t have to have that hassle and that burden on them. We try to get everything covered for them. And ultimately, if we are unable, if we fail in getting a charge covered; we don’t put that balance, that responsibility on the member. We write those things off. We take care of it in house.
Host: Well I love how you advocate for the patient. So, Denise, as we wrap up, what else should we know about the insurance process?
Denise: Pretty much Allison had covered as well, the insurance could be something that could be stressful but that’s our job. So, mainly our goal is so the patient doesn’t have to get involved. So, we just try to make it as easy as possible and stress-free for them and we want the patient to be excited and being happy with the care that are receiving her in the office.
Host: Well Allison and Denise, this has been great. Thank you so much for your time and talking to us about the insurance process.
Denise: All right, thank you so much.
Allison: Thank you Bill. It’s been a pleasure speaking with you and everyone in the audience today.
Host: And for more information, please visit the Garden State Bariatrics and Wellness website at www.gsbwc.com, that’s www.gsbwc.com. And if you found this podcast helpful; please share it on your social channels and check out the full podcast library for topics of interest to you. This is Winning Through Losing, a weightloss surgery podcast with Garden State Bariatrics. I’m Bill Klaproth. Thanks for listening.