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Prepare now for patients with limited benefit plans

Managed Care Weekly Advisor, February 14, 2007

As healthcare costs continue to rise, employers are feeling the pressure and are forced to reevaluate the health plans they offer to their staff. Limited benefit plans, which are gaining ground as an attractive option, are touted as an affordable alternative to more comprehensive health insurance plans.

Providers treating patients enrolled in limited benefit plans need to be able to identify these products and plan to ensure that they do not get caught between abandoning a patient and treating him or her without compensation. Following are four tips to make these arrangements work for both you and your patients.

  1. Check your payer agreements. Look at the terms of your existing payer agreements to see whether they permit individuals enrolled in these types of plans to be included.
  2. Know your payer policies. Because limited benefits are also found in standard plans or products, you must be prepared to respond to them among the plans that you currently accept.
  3. Gear up your front desk. It's critical that you identify patients who are enrolled in health plans with limited benefits and plan for how payments will be made if and when the patients reach their caps. This is especially true if a patient is undergoing a course of treatment that cannot be interrupted without raising the issue of patient abandonment.
  4. Plan for expensive services. Because patients can exhaust limited benefit plans unexpectedly, it is especially important to plan for the services that these patients will need.