There is a difference between helping a patient understand their insurance benefits and accepting the responsibility for it. Insurance coverage can be very confusing. Often a patient will depend on their medical provider to understand the details of their plan.  Because plans vary so much, this may not always be possible.

Most plans that have massage benefits do require a prescription from a physician, some require pre-authorization and others require a referral-all different processes. A customer handout that defines common insurance terms and provides a list of specific questions that a patient can ask their insurance company is one solution to help a patient understand their benefits.  The handout should clearly describe terms such Deductible, Out of Pocket Max, Co-pay, Co-insurance, Referral, Prescription, and Pre-authorization.  You should also state clearly in writing that it is ultimately the patient’s responsibility to understand their benefits.  However, helping your patients transverse the murky waters of health insurance coverage is a nice gesture.

What have you found helpful to prevent insurance coverage surprises, as either a medical provider or a customer?