Charting your patients' insurance: It's all in a simple grid

With one sheet of paper, a suburban Chicago practice found a way to navigate the maze of insurers' requirements for referral and reimbursement.

By Emily Berry, AMNews staff. Feb. 25, 2008.

Like fighting fire with fire, Vista Family Medicine fights paperwork with paper. As many practices do, Vista struggles with tracking the ever-changing rules and requirements of multiple insurers, with multiple plans offered by each.

Asking patients to know what's covered by their insurance wasn't going to solve the problem, because even if a patient claimed to know, the rules might have changed since the last visit.

So Vista, located in an office building attached to a hospital in the southwest Chicago suburb of Evergreen Park, put together a horizontal, 8½- by 11-inch, frequently updated quick reference sheet called the "Insurance Grid."

Even though the office has a computerized practice management and electronic medical records system, it has found that using the one-page grid, posted in the front-office area and the six exam rooms in the two-physician practice, was the quickest way to check the rules of insurance for its 3,000 patients.

The columns and rows in the insurance grid outline insurers' preauthorization requirements for diagnostic imaging, referrals to specialists and laboratory testing.

The grid doesn't make dealing with health plans pain-free. It is more like armor worn in a lengthy battle.

Even if the practice knows whom to call and what to ask for, staff and physicians still must spend hours on the phone or online asking for permission to order MRIs, lab tests or specialist consults.

But Vista's founding physician, Jim Valek, MD, said the grid does save him, his staff and his patients from wasting time on checking or arguing over coverage.