The patient wants to switch from self-pay to billing their insurance and has NOT been provided an estimate.
Billing Action: The agent MUST warm transfer the call to PTE. The PTE agent will then perform an estimate and make the switch if the patient decides to proceed with billing their insurance. Document the call and who it was transferred to in AMD and LIMS.
MEDICAID insurance is an exception.
If a patient is self-pay and wants to bill their MEDICAID insurance, those calls should NOT be transferred to PTE. Instead, our Billing agents are responsible for handling the insurance update.
Be sure to ask probing questions to determine whether it is Straight MEDICAID or Managed MEDICAID (this is only to ensure proper escalation). However, Billing agents will still manage the case.
If patients want to switch from Self-Pay to billing their TRICARE insurance, the call should be warm transferred to PTE.
Calls: If patients want to switch from Self-Pay to billing their PROGYNY insurance for Spectrum or Horizon, please warm transfer to Spectrum using this number 650.412.7251
Tickets: If patients want to switch from Self-Pay to billing their PROGYNY insurance for Spectrum or Horizon, please transfer the ticket to Spectrum PA Request
Please note that ANORA can’t be billed through PROGYNY
PTE Action
If the patient decides to proceed with the switch, the PTE agent must update the insurance information in LIMS and Submit an “Insurance Update” ticket via Syncro CRM. DO NOT update the insurance information in AMD. Leave clear and detailed notes in both AMD & LIMS.
Updating LIMS / Changing Payor in LIMS
- In LIMS Extranet, scroll to Insurance and click “Add Insurance.”
-In the Payor field, start typing in the insurance carrier
- In LIMS Extranet, scroll to Billing and Payment Information
- Click “Click here to change Billing instructions now.”
-Select “Bill Insurance – Special Billing”
-Hit “Update billing instructions on the case.”
- Submit an “Insurance Update” ticket via Syncro CRM
If the patient decides to pay for the Self-Pay invoice, the PTE rep can proceed with sending the payment link from Synergen Pay to complete the interaction.
Self-Pay to Billing Insurance FAQs
Do we use the note templates in AMD or LIMS?
Both! We should be using the same note templates.
Do we still need to provide an estimate if the patient states their insurance will cover the test?
Yes! An insurance can cover a test but still have the balance of the test applied to the deductible/co-insurance.
Is this only for PTE, or for any agent who has a patient wanting to switch?
A billing agent will need to transfer the call to PTE for an estimate before making the switch from Self Pay to INS
What if the patient wants to stay as Self Pay?
PTE rep can proceed with sending the payment link from Synergen Pay to complete the interaction.
What if the patient asks for billing options?
PTE will notate both AMD and LIMS. The PTE agent will then transfer to billing if the patient has any questions or need more payment options.
How do we handle tests that we do not provide estimates for?
Do not run an estimate. Utilize the INN or OON scripts that are currently available.
Related Link Immediate and Unk back to INS
Last update by: Nina O (Dec 18, 2024)