Turning Problems into Profits


We all know that HMO plans won’t pay for medical care without a referral, but you’d be surprised how often we get denials from insurance companies because the office saw the patient for medical care and no one got a referral. How can you avoid this? Always check the patient’s card! If it says “HMO” or has a primary care physician (PCP) listed, then the plan requires a referral for medical eye care.  Many of your insurance contracts put the burden for obtaining a referral on the provider, and the EOB shows the denial as a contractual write off. Even if your contract doesn’t stipulate and it’s your office’s policy that patients are responsible for getting all referrals, a courtesy reminder to patients can go a long way in gaining goodwill and saving the patient from a large bill they didn’t expect.