Patient may refuse to sign insurance waiver
They won't be too happy
If a patient is scheduled for a high-dollar imaging procedure on short notice, this situation presents some additional challenges with obtaining authorizations, according to Robyn Rogers, a patient access manager at St. Nicholas Hospital in Sheboygan, WI.
"We experience the majority of our problems from patients that are scheduled for same-day or next-day services," she says. "This doesn't allow adequate time to ensure that the authorizations are in place for high-dollar imaging tests."
Often, patient access staff are unable to reach the patient prior to service to let them know that their test isn't authorized, adds Rogers. "This conversation may need to take place when the patient comes in for the test," she says. "At that time, without the authorization in place, they are then required to sign an insurance waiver."
Some patients have refused to sign the waiver, due to the high cost of these imaging procedures, and refused to have the test, says Rogers.
If a patient is having more than one procedure, the payer might authorize one procedure but not the other, or might deny authorization on the basis that a test is not medically necessary, says Marsha Kedigh, RN, BS, MSM, director of admitting, ED registration, discharge station, and insurance management at Vanderbilt University Medical Center in Nashville, TN.
Patients might be surprised to learn that a service isn't going to be covered by their insurance, and patient access staff will need to explain that insurance companies are revising their guidelines, says Kedigh. "Certain procedures that did not typically require authorization in the past now do require authorization," she says.
If the authorization hasn't been obtained close to the date of service, Vanderbilt's insurance management staff contacts the physician office to inform them of this situation.
"If we do not believe the authorization will be obtained, or the physician does not deem it as 'medically necessary,' the patient will then be asked to sign a waiver," Kedigh says. "If the patient refuses to sign, it is left up to the physician on whether he wants to proceed with the case or not."
If a patient is scheduled for a high-dollar imaging procedure on short notice, this situation presents some additional challenges with obtaining authorizations, according to Robyn Rogers, a patient access manager at St. Nicholas Hospital in Sheboygan, WI.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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