12/13/2025    Keith Gurnick, DPM

Private Practice Management and Health Insurance 2026

Health insurance should be verified on each new
patient and each returning patient on every visit.
It is not enough to ask the patient, "is your
insurance still the same? Asking such a broad and
general question may make the office staff feel
they have done their job of checking insurance in
a kind and non-confrontational way, but this is
not focused enough. Patients need to be asked to
show their current member I.D. insurance card
which they almost always carry in their wallet or
purse, or they can also easily produce virtually
on their cell phone. A simple request from office
staff, "Can I please see your current health
insurance card, or cards)?" is a polite way to
check for insurance changes such as a new I.D.
card or different insurance altogether, policy or
group # changes, or plan coverage and benefit
changes including office visit co-pays. Assuming
nothing has changed is a way of the past.

Although time-consuming up front, doing it this
way is much more efficient than assuming the
patient's insurance has not changed from the prior
visits. Billing with incorrect information and
having to contact the patient at a later time, to
correct the mistake will cost you more time and
money. This is more important now than in the
past. Many patients, during the "open enrollment
period" will change their traditional Medicare
coverage to Advantage plans. Also, with the
"Obamacare" enhanced governmental premium
subsidies (aka premium tax credits) which are set
to expire, CNN recently reported to expect an
average of 17%-30% increase premiums and some
could even double.

Expect those plan members, your patients to either
drop coverage entirely, or switch to a higher
deductible plan with higher out-of-pocket costs
solely for the purpose of trying to avoid huge
premium increases, or to keep their premiums the
same, or as low as possible. For the doctor, this
means these patients will be purchasing insurances
that are simply repricing plans, that will pay the
doctor little or nothing and put more of the cost
of healthcare on the patient.

Keith Gurnick, DPM, Los Angeles, CA

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