Did you know that inaccurate patient eligibility verification could cost you thousands of dollars in lost revenue? Navigating patient benefits is a crucial step in ensuring providers get paid. Unfortunately, coverage for ABA, speech, and occupational therapy still has limitations and exclusions in many states.
Knowing whether ABA therapy is covered by insurance through proper verification of benefits will save many unfortunate billing issues down the line. Employers who provide self-funded benefits can choose to exclude or limit services, even if the state mandates that autism-related services be covered. For example, insurance that covers ABA therapy may be limited to a maximum of $35,000 in reimbursement per year, but you may receive ABA authorization that exceeds this cap. As such, it’s important to know exactly what services are covered. This foresight not only aids in smooth billing and service delivery but also aligns the expectations of both the provider and the patient, minimizing the risk of financial surprises.
The eligibility factors to look out for
Insurance eligibility verification requirements can also change throughout the year. Familiarize yourself with some of the possible changes that can occur:
- Some policies may not follow a calendar year and have a benefit year of July to June, for example. It is important to know the patient’s deductible, out-of-pocket costs, and the plan’s calendar period.
- Maintain open lines of communication with patients about job changes and how they will affect their insurance coverage. Do they have a grace period? Are they going to utilize COBRA coverage? Will there be new insurance?
- Since the Medicaid application process can be extensive and requires considerable follow-up by patients, providers may have patients who become eligible for Medicaid at different times of the year. Remember to communicate with patients about where they are in the process of obtaining any new policies.
- State changes can primarily affect children and their ABA therapy insurance coverage. Patients should know that moving to a new state will require ABA providers to review the local coverage and eligibility.
Stay informed and provide information for patients
Don’t let patients’ out-of-pocket costs get in the way of providing service, especially since the financial obligations of insurance for ABA therapy can be difficult to understand at times. If a patient does not understand their obligations, they may not be able or prepared to make payments when due. ABA therapy, in particular, can be very costly, and most patients reach their out-of-pocket maximum within weeks or months of starting services, which may amount to $5,000 or more in-patient obligations. Most patients cannot afford or plan for payments of that magnitude without advance notice. Setting up a payment plan in the initial stages of services helps reduce stress for everyone involved.
Get the best ABA billing service at Missing Piece
At Missing Piece, we complete a comprehensive ABA insurance coverage medical eligibility verification process before the initiation of services. Our ABA insurance billing service also includes ongoing verifications. We clearly explain benefit verifications in medical billing details to providers so they can offer services and implement practice management software within the scope of the benefit limitations. Contact us to learn more about our insurance eligibility verification services and other financial obligations we can help with, such as deductibles, copays, and out-of-pocket maximums. Don’t skip this critical step in the revenue cycle!