Strategy Review
In most cases insurance companies have 45 days to process the claim once they receive it. Key words, process, and receive. Remember, they make up to 50% of their profit from interest earned on your money. Not just premiums they have collected from patients. The insurance company strategy comes in four basic flavors.
- Delay claim submission
- Prevent claim submission
- Prolong the “processing” time.
- Take the money they paid back from the doctor.
Now we know their motivation. If you look at the chart below it is pretty obvious. What tactics to they use to make it happen?
Tactic # 9 – Post Payment Audits – SEE VIDEO
Now we have thoroughly explored the most common tactics used by insurance companies. The goal, to either prevent you from submitting claims or delay paying you for them. The latest trick up their sleeve is the post payment audit. This is where the look at the money paid to you and ask for it back, plus penalties, plus interest. It is scary by design. Insurance companies have figured out, using technology, who are the doctors who are least likely to defend themselves based on documentation, billing profile, practice size and other criteria we will never know. They have calculated that for every audit they pursue to the fullest they will get $13 dollars back for every $1 they spend. Not a bad way to make even more money. Remember we talked about in the beginning of this article, the insurance company takes your money that should be in your pocket and reinvest it? How do you feel now that you know their best investment is taking your money and auditing other chiropractors with it? What a racket and it is all legal. In some cases the accusation of insurance fraud has put the doctor out of business. Letters are sent to the patients by the insurance company. Complaints are submitted to state boards. Doctors are strong armed into paying just to avoid the legal battle. It’s the modern day witch hunt. It seems hopeless on the surface but with the explosion of web based technology around the world the scales are tipped back in our favor.
Now we have thoroughly explored the most common tactics used by insurance companies. The goal, to either prevent you from submitting claims or delay paying you for them. The latest trick up their sleeve is the post payment audit. This is where the look at the money paid to you and ask for it back, plus penalties, plus interest. It is scary by design. Insurance companies have figured out, using technology, who are the doctors who are least likely to defend themselves based on documentation, billing profile, practice size and other criteria we will never know. They have calculated that for every audit they pursue to the fullest they will get $13 dollars back for every $1 they spend. Not a bad way to make even more money. Remember we talked about in the beginning of this article, the insurance company takes your money that should be in your pocket and reinvest it? How do you feel now that you know their best investment is taking your money and auditing other chiropractors with it? What a racket and it is all legal. In some cases the accusation of insurance fraud has put the doctor out of business. Letters are sent to the patients by the insurance company. Complaints are submitted to state boards. Doctors are strong armed into paying just to avoid the legal battle. It’s the modern day witch hunt. It seems hopeless on the surface but with the explosion of web based technology around the world the scales are tipped back in our favor.
