News and Notes from The Johnson Center

Documenting Insurance Company Communications – A Worksheet

JCCHD | Thu, June 25, 2015 | [Autism Treatment]

In our webinar Understanding and Optimizing Your Health Insurance Coverage: What Every Parent Needs To Know, we provided a link to a very helpful step-by-step worksheet.  Before you pick up the phone to call your insurance company to inquire about your coverage, you’ll want to have this worksheet in front of you and a pen ready.  Getting all of your information is much easier if you follow the worksheet questions.  The worksheet is also a great way to stay organized—it has the who, where, what, and when details of the insurance phone calls so that you can document and file them for future reference. 

The worksheet asks for the relevant information: the Practitioner NPI (National Provider Identifier) number, the clinic tax ID number, credentials, and clinic address, and all the details that your insurance representative will likely ask you.  There are boxes to check if the services are in- or out-of-network, as well as space to write the name of any specific representative who may be assigned to you on an on- going basis.  If you are an existing patient, it is possible that your clinic will be able provide the CPT codes that describe the service you are pursuing, which will aid in confirming coverage.  Every worksheet has reminders to note the name of the insurance representative you are talking to and the date and the time of day, in addition to the all-important Call Reference Number.

Worksheet  1

Many important reminders are included and easy to check off: is there a ceiling (maximum) on the number of this type of appointment allowed in your policy?  Have you met your deductible? At what % is this appointment going to be reimbursed?  What is the co-pay?  Does the practitioner need a specific credential for it to be covered?  Does it need pre-authorization? How many days does insurance have to provide a reimbursement check to you?

Once you’ve made your insurance call and your worksheet is complete, file it in your insurance binder.  You can mark your calendar to follow up on reimbursement checks and use the details of the worksheet to appeal a claim if needed.

The full worksheet is available on our website at: