Top 5 Insurance Related Tips for Making the Most Out of Your Next Office Visit

By Rhonda Pfaffly, Referral Coordinator for Lee’s Summit Physicians Group

Lee's Summit Physicians GroupThe following tips are the top five common questions we hear related to insurance and first visits with our providers.

What should I know, especially a new patient visit to make the most of my visit with my doctor?

The best thing keep in mind is KNOW your insurance. We, as your health care provider and staff, don’t know everything about your insurance. And please be prepared to pay your co-pay.

Educate yourself on your co-pay amounts for your Primary Care Physician and Specialists

If there’s anything you need to know about your healthcare coverage (besides which physicians are in your network), it’s your premium, deductible and copay amounts—call the number on the back of your insurance card to get this information. Be prepared to pay your co-pay and to present your insurance card and photo ID at every visit.

What will my provider need at my first visit?

Be proactive and have a list of medications, strengths and how you take them. Be prepared to list allergies, past surgeries, and past medical and family history. This will save the nurse time, and the faster they can get all this information entered into your chart, the more time you will have with your physician.

Make a list of questions for your provider. (*Note* They may not be able to address all of your issues in one visit.)  If you have a chronic condition such as Diabetes or hypertension, it would be helpful to keep a log of your blood sugars or blood pressure readings to make sure you are on the correct medication and dosage. Remember to be your own advocate!

How do I know if my insurance requires a referral?

The best way to know if your insurance requires referrals is to contact your insurance carrier directly. The phone number should be located right on your insurance card. Your insurance card may even indicate if you require a referral directly on the card itself. If this is the case, make sure the nurse is aware that you need an insurance referral so it can get to the proper staff that handles the insurance referrals.

Many specialists will need a physician-to-physician referral which will include a fax from our office stating why you are being referred to them. We normally fax the order, office notes, insurance information and labs, x-rays or anything else pertinent to why you are being referred to them. We do our best to make sure we are directing you to a physician that is in your network, but ultimately this is up to you to verify prior to your appointment with that specialist.

Learn which physicians and practices are in your provider’s network.

Even though you have health insurance, that doesn’t mean you can visit any doctor or hospital and be covered. We do our best to keep you within your network, but you’re responsible for knowing what hospital you can go to, specialists you may be referred to and what lab and pharmacy your insurance prefers.

With all this information, I hope your next visit to your physician’s office will be more efficient and informative for you!

2 replies
  1. Penelope Smith
    Penelope Smith says:

    This is some really good information about getting insurance. I liked that you pointed out that you should get a referral. That does like a good thing to talk to people who you trust about as well. I know that I Would want to hear first-person accounts on if an insurance company is good.

    Reply

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