Self Pay after Insurance Program

Customer Service is the foundation of Eligibility Plus, Inc. Our Self Pay after Insurance or (SPAI) program provides that customer service.

Instead of having your employees work small dollar and high volume accounts, we will do that for you. Wanting to do things a step above, we designed the following program:

• Within 48 hours of referral, a trained patient accounting representative will call the patient, let them know their insurance has paid and ask if they have any additional questions regarding their balance. This lets the patient know we are interested in their questions and want to help them understand their balance.
• EPI also sends a letter to each referred patient thanking them for providing their insurance information to the hospital; informing them that their insurance has paid; and letting them know about their current balance. EPI then has the opportunity to answer any questions the patient may have.
• EPI created a department to review accounts with balances over $1500 after insurance has paid. When necessary, EPI will work with insurance companies to make correct payments. If payments were correct from the payer, EPI employees will do the following:
  • Set up a payment plan within client guidelines
  • Look at other funding sources such as Medicaid or Medi-Cal
  • Take a charity application

THE RESULT Reduced calls to client staff with patient questions about their small balance Added time for client staff to work high dollar and more complex accounts The patient feels the hospital wants to help them understand billing Increased payment within 30 days on SPAI accounts Reduced Bad Debt Increased Patient Satisfaction