Nurse Regestries & Agencies: How to Increase Revenue Stream and Quality of Service
Many of my registry clients are told that their policy benefits have been maxed out. Consequently, when registries or agencies are no longer getting paid by the insurers, they look to their clients to step in and pay. In many cases, these clients cannot afford to pay, and more often than not, the registry or agency will stop providing care, and essentially lose their client as a result.
This happens primarily for two reasons:
First, once a registry or agency pursues claims against their own client, they are no longer a client. In a sense, they become adversaries. Something that registries and agencies should take note of is their ability to sue insurance companies on their own accord, so that this doesn’t happen. If they take an assignment of benefits from a client and a controversy arises about a short pay or some problem with payment, the registry or agency is entitled to sue the insurance company themselves under the assignment, and have exactly the same rights as the insured person. If under the assignment they are successful in getting payment, they can get their fees paid under the same Florida statute that entitles an insured person a reimbursement for their fees, in the event that they had to sue for benefits. Being aware of this can be crucial in maintaining good client relationships and avoiding an unnecessary adversarial posture with clients.
Secondly, many registries and agencies are a bit too hasty when an insurance company states that a policy benefit has maxed out. It is crucial that these entities do their own due diligence and review the policy benefits and parameters for themselves. When I examine many of these policies, I frequently find that the insurers are wrong for a variety of reasons, and that policy benefits are in fact not maxed out. In many of these instances, my team and I are able to get the policy to continue providing benefits to the insured person, without them paying out of pocket.
Thorough policy review is something I always try to educate registries and agencies about, because it is something they can and should do themselves. Ultimately, taking the time and effort to review and understand client policy benefits is always helpful. And, in the instances where the policy is in fact not maxed out, you continue to get paid, alleviate pressure on your client to pay out of pocket, and avoid creating an adversarial dynamic. So everybody wins.
Ultimately, understanding the nuances of client policies allows for more transparency, accountability, and efficiency. Having a clear understanding of your role in a client’s care management can only enhance your relationships with them and thus enhance your quality of service.