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FAQ
Here is a few of the most frequently asked questions that a medical insurance clerk may have to answer or want to know themselves.
What is Medicare?
What is Medicaid?
What is Tricare?
Why must I pay Copays?
How much is my deductible?
Why do you need my Social Security Number?
Why do you need to know my religious preference?
General Insurance Questions
Q: What is Medicare?
A:
Medicare is an insurance offered by the Federal Government to retired persons who has paid into the fund through an employer or can be qualified for coverage by their spouse who paid into the program. Medicare is also offered to certain individuals who qualify through a disability either physical or mental and attested to by a doctor.
Q: What is Medicaid?
A:
Medicaid is an insurance offered by the State in which the patient resides. It is generally offered only to those people who have a medical or mental disability and have no other resources to pay for their medical insurance or haven't qualified for Medicare. The patient's have to fill out an application with the local Medicaid office and prove that they are unable to pay for insurance themselves or through an employer. Most states have programs in place that covers the most needy uninsured patients such as children or the mentally handicapped.
Q: What is Tricare?
A:
Tricare insurance is only offered to those patients currently in the military and their covered dependents. Tricare is also offered to those who have retired from the military along with their covered dependents. Tricare requires that the sponsor maintain current information on themselves and their covered dependents in the DEERS system.
General Coverage Questions
Q: Why must I pay Copays?
A:
Every insurance has a certain portion that the patients must pay on their own. HMOs particularly require that the participating providers collect copays at the time of service.
Q: How much is my deductible?
A:
The patient will have to contact their insurance company to find out how much of their deductible still remains to be paid. Their patient information booklet from their insurance plan will have the total amount due each year. The doctors office or hospital person may have access to that information if they participate with an online verification service such as WebMD Office or Passport.
General Hospital Services Questions
Q: Why do you need my Social Security Number?
A:
Yes, everyone in the hospital has several numbers the computer system uses to keep their records and information separate from the other patients. However, as with any service the patient desires to seek and asked for financial consideration the doctors office and hospital have a right to make sure that the patient pays their bills. If they don't they have the right to report that lack to the credit bureau.
Also, some state, county and federal programs requires an accounting of the services we provide to patients. We are required to make sure we have the correct patient to decrease the risk of medical insurance fraud. One of the main things we are required to collect is positive ID of our patients.
Some insurances, such as Medicare and Tricare, requires that social security number to be placed on the billing form as part of the patient's policy number and to be able to verify that the patient is actually covered by that insurance plan.
Q: Why do you need to know my religious preference?
A:
This question gets asked quite a lot. Hospitals and doctors office as well tries to respect everyone's religious background as far as those beliefs impact the care of the patient. Some religious preferences have specific dietary requirements others automatically will refuse the administration of blood and blood products. It is much preferable for those who are trying to give the patient the best care and treatment if they are made aware of these needs ahead of time.
Medical Office Clerk Blog
Created by Jolene MacFadden (c) 2011 Last Updated: January 22, 2012 Online Since April 2008
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