Patient Authorization Forms Are Necessary

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2 Min

The Out-of-Network VS. In-Network world in healthcare is changing
Source: Wakefield
April 19, 2024

Patient authorization forms – or shall we say, payor specific authorization forms… are time consuming and at times overwhelming. BUT, it IS worth the inconvenience to maximize the reimbursement on your claims in a timely manner!

As we go through more and more challenges in the health insurance industry, we are always on the lookout for the next payor roadblock. On top of making sure claims are paid correctly according to the members policy, the payors are looking to continue to reduce denials and / or the amount they pay per claim impacting a provider’s bottom line.

Now, they are requiring their own specific Authorization Form, and won’t move forward without it. This form includes nearly exact language as a standard Assignment of Benefits Form signed by the patient. It just goes to show they’ll do anything to prevent a fair reimbursement opportunity.

What is the Significance?

An Assignment of Benefits / Patient Authorization Form is significant because it authorizes the insurance carrier to send the payment directly to the treating healthcare provider. They also will allow medical providers the right to appeal denials and underpayments from the Insurance Carrier.

Patient Authorization

So how does it all work?

Although a payer may pay well, does your geographic location have patients with these plans?  Are the physicians who work at your facility able to bring those patients to you?  Deciding to market to a market that simply does not exist is both time consuming and financially wasteful. Knowing that there is a population out there and that there is an ability to bring them to your practice helps determine where to spend those hard-earned marketing dollars. 

When did it take effect?

Aetna, effective 10/1/2020 for Fully insured plans, and 1/1/2021 for Self funded plans, quietly implemented the requirement for their Authorized Representative Form. This form is to be completed by the member in order for the provider to send a request for Patient Advocacy. They also will not accept a providers AOB in place of their authorization form. The change in the requirement for the specific form is not on their website. Aetna does not even provide instructions on how explain how to complete the form. Nevertheless, if the Authorized Representative Form is not completed correctly, they will refuse to review the claim.

By changing the guidelines on how and what information must be included, the payors stay one step ahead. If you are checking an incorrect box, or if the signature and date signed does not match up to their internal guidelines, they will not release the information to the provider. They will also not review the claim causing the provider lost opportunity to maximize the reimbursement that should have been allowed based on the plan. Aetna will not review a Self Funded claim for Patient Advocacy after 180 days from the process date so make sure that the Authorized Representative Form is available.

How we can help

Collect Rx can help you through the challenges. We can provide you the forms, walk you through how to complete them to avoid any further delays.