How many times have you heard, or even said, “Because I Said So” when asking the question, Why? I know as a child, my parents would simply reply in this same manner when I asked Why. In fact I have to admit that I have even used the response with my children as well, a time or two…although seldom.
The fact is, asking the right questions can sometimes lead to getting the right answers to satisfy the why factor. In addition, when answering the question at once, you leave less room for the same question to come up again and again at a later date, which may ultimately lead to further frustration from both parties.
For example, I recently verified insurance for a couple of patients to determine eligibility and coverage of benefits for a Knee Orthosis. When speaking with a customer service representative from the insurance company, sometimes I believe they are programmed to give you very basic information about the patient’s eligibility and coverage, and try to leave it at that. This is where your expertise comes into play…I let the CSR give me the low down on the basic coverage and benefits, and then I was in hot pursuit to inquire about more specifics about the coverage and benefits.
I proceeded to ask if there were any limitations, exclusions and/or provisions on their plan pertaining to Orthotics. That is when the CSR came back with the answer…Prefabricated Knee Orthosis are not a covered benefit under the patient’s benefit plan. Hmmmmmmm, I thought. Had I not asked, they would not have told. Had the practitioner fit a prefabricated KO, then the claim would have been denied. If the claim had been denied, then you would probably have a very angry patient who finds out later that they may have to pay for the brace out of their own pocket, or they would have a legitimate argument to avoid paying the bill because you or your staff may have told the patient that the Knee Brace was covered, when in reality it wasn’t for a prefabricated KO.
In a nutshell, it is alright to ask “Why” when you feel that you need further explanation. This is especially important when you’re dealing with insurance companies to verify insurance. The key is to “ask the right questions” so that you can determine if you will be paid for your services. Are you asking the right questions pertaining to the type of service(s) that you plan to provide to your patients? If not, you could be in a heap of trouble!