The new year is just around the corner! As such, your clients may come to you with questions about their coverage for the remainder of the calendar year and heading into the new year, since many insurance plans will “re-set” come January 1st. How do you know how many nutrition counseling appointments your client is allotted for the remainder of this year? And what does coverage look like come January 1st – has anything changed?
How do you know whether to collect a copayment from your client? And if you do need to collect a co-pay, when do you collect it? Let’s dive in!
Whether or not your client is required to pay a co-pay, or a fixed amount that one pays for a covered healthcare service after the deductible has been met, is determined by the client’s health insurance plan.
You may have clients who have health insurance coverage via multiple insurance plans. Why might your client be covered under two plans? One reason may be they have primary insurance through their own employer, and secondary coverage via their spouse’s or partner’s insurance plan. They may also be a dependent under another person’s plan.
When you file a claim to an insurance company and it gets finalized, you, as the provider, will get remittance advice, which explains the insurance company’s rationale for that claim’s payment (or lack of). The remittance advice is sent to you as a written summary of what the insurance company will cover for a particular claim. The remittance advice outlines what the insurance company paid, the amount that was applied to a client’s deductible, and what amount may now be due from your client. It’s oftentimes accompanied by a check or statement of electronic payment.
Think about where you conduct the majority of your nutrition counseling visits – are they at your office, an MD’s office, or perhaps your home office? Do you conduct home visits or see clients via telehealth sessions?
Did you know there are approximately 100 different location codes for use when filing claims?