When Medicare and Marketplace open enrollment collides with end-of-year deductible resets, podiatry offices feel the squeeze. Patients can review or switch health plans between mid-October and mid-January, and any changes take effect at the start of the new year. For clinics, this window means higher volumes of calls, eligibility questions, and documentation-especially since patients want to use expiring FSA funds before they lapse, if your front desk is juggling phones, forms, and prior authorizations, virtual medical assistants (VAs) can provide insurance season support so you stay ahead.
Why insurance season hits so hard
- Multiple open enrollment windows. While Medicare open enrollment runs from October 15 through December 7, ACA Marketplace enrollment runs from November 1 through January 15. Patients use this time to join, switch, or drop plans, generating an avalanche of coverage questions and admin tasks.
- Increase in number of patients’ inquiries and appointments: According to an open enrollment article from HireHealth, healthcare facilities face a surge in the number of patient inquiries and appointments during this period; patients also rush to schedule procedures before year-end so deductibles and FSA dollars don’t expire.
- New coverage verification requirements: At the start of a new year, many patients have new insurance plans. Failure to verify eligibility is the #1 reason for claim denials. 60 % of medical group leaders reported that claim denials increased in 2024. Practices that reduced denials credited enhanced eligibility verification and authorizations.
- Prior authorization delays: In a survey conducted by the AMA in 2024, 93 % of physicians said prior authorization delays care, 89 % said it is contributing to burnout, and 82 % said it can lead to treatment abandonment. Insurance season magnifies these delays as the rules change and the new plans have different requirements.
Where podiatry clinics feel the bottlenecks
- 1. Phones & Scheduling: call volume spikes for coverage questions, plan changes and to request appointments. No shows increase as patients shop for new plans or seek earlier visits.
- 2. Eligibility & benefits verification: Staff should verify deductibles, copays, secondary coverage and FSA balances for each patient. If not verified up front, it leads to denials and costly rework.
- 3. Prior authorizations & referrals: New insurers may require fresh authorizations for orthotics, surgeries or physical therapy. The AMA reports that prior auth delays patient care and contributes to burnout.
- 4. Claims & billing questions: Patients call to question EOBs (explanation of benefits) and out-of-network charges; staff must interpret coverage and resubmit claims, as needed.
- 5. Documentation & EHR updates: Insurance cards need to be scanned and uploaded, benefits scripts updated, and patient records reconciled with new coverage.
- 6. Patient education: many patients do not comprehend how deductibles, coinsurance or FSAs work. It is here practices have to invest time in educating them amidst heavy call volume.
How VPP’s VAs Provide Insurance Season Support
Virtual Podiatry Partners provide podiatry-trained virtual assistants to handle the administrative burden, freeing your clinical team up to focus on patients. Here’s how they make insurance season manageable:
- Eligibility and benefits verification: VPP VAs verify insurance coverage of patients; deductibles and copays before their visit. This prevents denials and billing surprises. They can request authorizations and gather referral information necessary to reduce delays.
- Phones, Scheduling, and Recalls: VAs answer calls, triage coverage questions, and schedule/reschedule appointments. They manage recall lists and waitlists to keep the schedule full even when patients change their plans.
- Billing & claims support: VAs will help with coding and billing, expedite claims, and follow up on rejections.
- Document management: They scan and upload new insurance cards, update patient demographics, and file consent forms in the EHR. This keeps charts current and ready for the new year.
- HIPAA-compliant, bilingual support: VPP VAs are trained in HIPAA and provide communication in both English and Spanish, thus ensuring clear communication with diverse patient populations.
A step by step insurance season game plan
- Define the scope: Identify 3–5 high impact tasks to offload: eligibility checks, prior auths, phones/appointments, EOB questions and documentation. Provide VAs with access to your practice management and billing systems.
- Script and template development: Standard responses to most common insurance questions, FSA deadlines, resets on deductibles and explanations of coverages should be developed. Offer a checklist of documents required for new patients.
- Train & onboard: Walk your VA through your workflows and policies. Introduce them to your EHR, billing software, and phone system. Emphasize HIPAA protocols.
- Phased go live: start with phones and eligibility verification, then layer in prior authorizations, claims support, and recall campaigns. Hold daily huddles for the first week to iron out questions and refine scripts.
- Monitor & optimize: Monitor key metrics such as call answer rate, average speed to answer, verification turnaround, and claim denial rate. As volume changes, adjust workflows and responsibilities accordingly. Provide your VA with feedback each week to continually improve service.
Quick checklist for insurance season readiness
- Secure insurance season support, from eligibility verification to prior authorisations and claim follow‑ups.
- Map open enrollment windows. Medicare: Oct 15–Dec 7 Marketplace: Nov 1–Jan
- Pre verify insurance for all scheduled patients; update each patient’s coverage and collect new cards.
- Prepare a script for staff or VAs outlining deductibles, coinsurance, and FSA rules.
- Assign a VA to manage prior authorizations and track expiring authorizations. Provide oversight of daily payer portal reviews.
- Audit claim denials each week; resubmit or appeal promptly to preserve cash flow.
- Offer evening or weekend call times for working patients; manage waitlists to fill openings.
- Update your website to include links to FAQs on open enrollment and FSA deadlines.
FAQs
What is “insurance season,” and why is it so challenging?
Insurance season is the time period of Medicare and ACA open enrollment mid-October through mid-January, and the beginning of the new plan year. During that time, patients switch or renew their coverage, FSA funds expire, and deductibles reset, which means high call volume, new coverage verification, and more paperwork.
Can a virtual assistant manage insurance verification and prior authorization?
Yes, VPP VAs are trained to verify benefits, collect prior authorization numbers, and submit required documentation through payer portals. This front-end work prevents claim denials and reduces delays.
Will using a VA affect the patient experience?
Quite the opposite. VAs answer calls faster, explain coverage and FSA deadlines more clearly, and perform follow ups in a timely manner. Physicians have more time face-to-face with patients, enhancing satisfaction.
Which tasks should we offload first?
The most acute direct-patient touchpoints to lead with would be eligibility checks and phones/appointments. Then layer in prior authorizations, claims follow up, and documentation support as capacity stabilizes.
How long does it take to see results?
Practices often see reduced wait times on calls and fewer denials in a matter of weeks. As your VA refines scripts and workflows, denial rates and administrative stress continue to drop.
Keep your front desk steady during open enrollment and the new year surge. Schedule a call to right-size your insurance season support and protect patient access. Your practice deserves a calmer end of year.
