RE: Insurance cards with no Insured ID

William Openshaw Fri, 19 Sep 2003 11:54:58 -0700

Doug,

As a human being who often has health problems which require a visit to my doctor, I can understand the frustration that will exist with an Identification Card that doesn't provide the proper identification. The problem is most payers use the members SSN as their Policy #, or Member ID.

But as a payer, you have to realize that state law may not permit us to send information that contains the SSN. Also HIPAA may require us to de-identify our correspondence to certain individuals or entities, which causes problems in properly identifying the individual. We are currently in the process of removing the SSN from our ID cards, and I personally think that this will cause a relatively large amount of confusion. Like one reply mentioned, when seeing your normal physician, they should already have this information on file, therefore it's a non-issue, but for visits to the emergency room, or referrals to specialty doctors, the ID cards that are presented at the time of visit will be inadequate to properly bill the insurance company. The option of the physician's office calling the payer to obtain this information is also, IMHO, another unnecessary step enforced upon the provider community by these laws that are preempted to protect the rights and information of the patient. Regardless if the provider reaches a competent Customer Service Rep at the payer office. If that answer were given by one of our analysts, rest assured that it is unacceptable and disciplinary action would most certainly be explored. I'm speaking for my company, and can't vouch for any other payers, but I pray that they would also agree.

So the problem here is that we all have to deal with the new laws and regulations that are being demanded of the Health Insurance industry, regardless which avenue you and your company do business on. The approach that we all have to take (payers, providers, CH's, health plans, individuals) is to reach a solution that complies with the new demands, but also allows us to operate business on a level as close to "status quo" as possible. Albeit, assigning each individual a unique ID other than a SSN is a little too much "Big Brother" for most people, we must identify a way to achieve our business goals. We can do this by either educating the member community that when asked for their ID Number, they must give the policy holders SSN, or by providing the Provider community a unique way to identify members. Simply taking the stance that we will just bill the patient and let them deal with the payer is somewhat of a "copout", and will only upset your members. We all know that you have a much greater possibility of receiving a timely payment from a payer than trying to fight it out of a patient. Especially in today's economy.

I don't have the answer. I wish I did. Although I am fairly confident that the people associated with this forum will provide great alternatives to most of our problems. Perhaps not the answers that we are all looking for, but we need to stop pointing fingers and casting blame at each other. Either we work together or it doesn't work.

-----Original Message-----
From: Doug Webb [mailto:[EMAIL PROTECTED]
Sent: Friday, September 19, 2003 10:05 AM
To: WEDI SNIP Transactions Workgroup List
Subject: Re: Insurance cards with no Insured ID

Susan,

1) Blaming HIPAA for this fiasco is totally bogus.

2) "I dunno" is a totally unacceptable response from the insurance company.

3) If you can't get a vaild insurance ID, you can't file a claim. A 270 query MAY reval the proper information. You shouldn't have to do so to get a valid ID. Bill the patient. Inform the the insurance company that you will do this, and will give the patient X days to pay before being referred to your collector. The insurance company will probably respond "You can't do that!"; you can respond "We can and will if you don't clean up your act!"

The opinions expressed here are my own and not necessarily the opinion of LCMH.

Douglas M. Webb
Computer System Engineer
Little Company of Mary Hospital & Health Care Centers
[EMAIL PROTECTED]

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----- Original Message -----

From: Susan Hollabaugh

To: WEDI SNIP Transactions Workgroup List

Sent: Friday, September 19, 2003 07:17 AM

Subject: Insurance cards with no Insured ID

We have begun receive patients in our California Imaging Centers who present
Insurance cards with no Insured ID.

Here is the experience as reported from our Director in the region:

"One Health Plan and Aetna are issuing new insurance cards without the
Insurance Identification Number. I called both insurances to ask why, and
was told, "HIPAA". Both are in the process of issuing new cards to ALL
members

So I asked, the patient, "what is your Insurance ID number?". "I dunno" ,
was the answer

So I asked the insurance companies, "are we to assume that the ID number is
the social security number?" "I dunno" , was the answer. They would not
provide me with the ID number."

How are we going to bill a patient's insurance company under these
circumstances? How are others dealing with this situation? Will this
necessitate Eligibility verification? Could we find the information that we
need that way? If this extends throughout the market, it will be a nightmare
for providers.

EDI Project Manager
8754 Dunstable Loop
Bristow, VA 20136
(703) 369-5775

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The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time.

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RE: Insurance cards with no Insured ID

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