CONSENT FORM PROCEDURE
What is an AOB?
The consent form or “AOB” (Authorization of Benefits) is a document that Medical Supplu Inc. (MSI) is required to have on file to stay in compliance with DME Supplier Standards. The AOB is explained in detail to a consumer when they initiate services with our company. The form says “Authorization for Release of Information” at the top and has the consumers name and identifying insurance factor on it as well.
This form authorizes MSI to bill the consumer’s insurance company for rendered services; and to release the patient’s privacy information (if need be) to insurance companies, doctor’s offices, etc.
By signing the form the patient avoids any delays in the future services and agree to all of the following:
- The patient understands that they have the right to access their health information at anytime and that they have the right to request MSI amend any health information that they are given.
- The patient understands that at any time they have the right to restrict or revoke their consent by contacting MSI.
- The patient understands that they are aware that MSI will bill them for any deductible and co -payment charges or equipment (if any).
- The patient understands that if any item was to be denied by the insurance companies it would be noted on the form by a representative at MSI. Furthermore, the patient guarantees payment to MSI if any charges are not covered through the insurance.
Why do we need to obtain AOB?
The consent form is required, in order for our company to stay in compliance with the DME Supplier Standards. The primary reasons we need to obtain the consent form are listed below:
- To authorize our company to bill the patient’s insurance company for services rendered.
- To avoid any delays in the patient’s future services.
** The consumer cannot receive another order from MSI unless we have the consent form on file.
When and why do we follow up on consumers regarding AOB?
Before the first order goes out each month, CSRs review the consent form and its importance with with the patient. After the order was delivered CSR’s should then follow up with the consumer to ensure that the consent form is sent back in a timely fashion. As a courtesy, CSRs should NOT contact the consumer regarding the consent form until the patient has had order in their possession for 2 DAYS.
- To know the status of the consent form
- (Ex: Consumer mailed it last week, consumer misplaced it, etc.)
- Inform the patient of the reasons why we need the consent form back.
- That they cannot receive another order until the consent form is received.
- We cannot bill the insurance company for their supplies, until the consent form is received.
BEFORE making the follow-up call to the consumer, the representative should complete the following steps:
- Pull the consumer up by their customer ID number.
- Check on the status of the consent form
- ALWAYS read the notes before calling the consumer.
Whenever a representative creates a note in the system concerning the consent form they should follow the guidelines listed below:
- CALLER: Who you spoke with
- TOPIC: AOB FU
- NOTE: What happened on the call
- Ex: The consumer mailed it 5/6
IMPORTANT TO REMEMBER
When making the actual follow up call to the consumer CSRs, CSRs should remember the following:
- To speak clearly & slowly so that the patient will understand.
- Keep in mind that a majority of MSI’s consumers are elderly and may be hard of hearing.
- If a consumer asks a representative to speak up, please do so. It may may seem as though you are shouting into the phone, but depending on the consumer you may have to speak at that volume to be heard.
The insurance will NOT pay for supplies if a consumer is any type of the following facilities:
- Nursing home
- Rehabilitation center
Exception to this rule is if the consumer is in an Assisted Living Facility.
- If a representative performs a follow up and was told that the consumer is in a facility, we should inform the caller of the following:
- The supplies have to be temporarily put on hold while patient is in the facility because the insurance will not cover the items that will be delivered.
- Once the consumer is discharged and the consent form was received, services can be restarted given that we have everything that we need to restart the order. Ex. Valid RX, state eligibility is okay.
ALWAYS read the NOTES before calling ANY consumer/care manager.
- If you see a note saying “NO AOB, NO ORDER” It means because the AOB is not in, we cannot send the consumer their order.
- If you call the consumer and there is no answer, no voicemail, call all the other contacts.
MAILING OUT AN AOB
When re-mailing the consent form to a consumer, CSRs should be sending all of the following for convenience:
- AOB Form (Consent Form)
- AOB Cover Letter
- Self Addressed Stamped Envelope
CSRs should highlight where the consumer or authorized representative must indicate the date and signature.
COMMON RESPONSES OR CONSUMERS TO THE FOLLOW UP CALL
“I DIDN’T GET IT”
If a consumer states this response, explain to them that this form was mailed out to them when they first started services. If MSI did not receive it back from the consumer by the time of the first order, it was put in the box with the patient’s supplies along with other documentation for the consumer. Verify that the patient checked the box and other documentation, if they still do not have anything let them know we are going to re-mail the form with a self-addressed stamped envelope.
“I ALREADY MAILED IT”
CSRs should try and get an exact time frame from the consumer (yesterday, Monday, etc.) If they are unsure have the patient estimate. Be sure to use your judgement on whether or not we should have received the consent form already or not. It depends on where the consumer lives.
Explain to the consumer that we might not have received it, maybe it was lost in the mail. Inform the patient that we will be re-mailing the consent form along with a self-addressed stamped envelope for convenience. If the consumer becomes irate, apologize but explain why we need the consent form back. Usually the consumer will understand and will send the consent form back to us so we could bill their insurance accordingly.
CSRs should ensure that the address we have in our system is verified accurately before sending a new consent form.
“I’M NOT SIGNING IT, IT SAYS I’M PAYING FOR IT”
There is a section on the consent form that reads “if my insurance denies payment, I agree to be personally and fully responsible for payment.” which sometimes causes panic in consumers. CSRs should explain that the consumer would only pay for items that their insurance denied of covering. But if that space is left blank, then it means that the consumer’s insurance agreed to cover the current prescribed supplies, and that they wouldn’t have to pay for anything.
“THEY ARE IN THE HOSPITAL/NURSING HOME”
Anytime a consumer goes into a facility (nursing home, rehab, hospital, etc.) The orders must be put on hold because the insurance will not cover it. The reason behind this is that the insurance feels that the consumer’s supplies should be provided by the facility or institution where they are admitted in.
Instruct the family to contact our office when the patient has been discharged so that we can resume our services.