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 above it is pretty obvious. What tactics do they use to make it happen?
Tactic # 6 – Technology
Insurance companies, relative to individual chiropractors, have unlimited money and resources. Recently you may have heard of insurance companies sending letters to doctors telling them they are billing X code outside of the statistical norm. They do not have a person counting the number of claims and codes and creating pie charts. They have invested millions into software to profile each doctor. As a matter of fact the new NPI number makes it even easier. Rather then each insurance company tracking a doctor individually, theoretically, all insurance companies can track each doctor in one database. In addition technology is used to route claims to billers so they can decide if they need to be denied but more likely never have a human touch point at all. Technology can analyze claims statistically and underpay, deny automatically without any human interaction. Even printing and mailing is automated.
With technology insurance companies are able to outsource the incoming calls for claims to foreign countries where labor is much cheaper. Since the technology is web based the outsourced resource can look directly into the same system a biller in the US would be looking at. In essence there is no difference other than the cost of labor. There are literally hundreds if not thousands of calling centers in countries like India where insurance companies outsource this work. How can you compete with the size and resources of a big insurance company?
Insurance companies, relative to individual chiropractors, have unlimited money and resources. Recently you may have heard of insurance companies sending letters to doctors telling them they are billing X code outside of the statistical norm. They do not have a person counting the number of claims and codes and creating pie charts. They have invested millions into software to profile each doctor. As a matter of fact the new NPI number makes it even easier. Rather then each insurance company tracking a doctor individually, theoretically, all insurance companies can track each doctor in one database. In addition technology is used to route claims to billers so they can decide if they need to be denied but more likely never have a human touch point at all. Technology can analyze claims statistically and underpay, deny automatically without any human interaction. Even printing and mailing is automated.
With technology insurance companies are able to outsource the incoming calls for claims to foreign countries where labor is much cheaper. Since the technology is web based the outsourced resource can look directly into the same system a biller in the US would be looking at. In essence there is no difference other than the cost of labor. There are literally hundreds if not thousands of calling centers in countries like India where insurance companies outsource this work. How can you compete with the size and resources of a big insurance company?
Wouldn’t it be nice if you could have a biller in India call the insurance company in India? All of our doctors are doing this now.
