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 # 7 – Benefit Verification
Have you ever called to verify patients benefits? I’m sure you have and I am sure you have also been frustrated when the person one the other end of the phone is in India and can barely speak English. This is not a mistake. It is a tactic. Other parts of the verification process are designed to ultimately cost you time and money, frustrate you to the point where you “go cash”. There is the deductible family and individual, co-insurance/copay, allowable amounts, contracted amounts, in network, out of network, maximum benefits for a year and lifetime and so on. Hundreds of more combinations right? At the end of the call you think you know how much you might get only to find out the person gave you the wrong information. You have already submitted 20 claims, now what? This is no accident and it cost you at least 30 minutes in man hours to get the information. 30 minutes X $15/hour equals $7.50. It cost the insurance company maybe $1. They are kicking your butt. If it were $1 for you it wouldn’t be so bad. Some docs are also outsourcing this to India. This is one thing we help our clients do. This process is one of those that takes so many man hours that it just drains your staff and they are unable to focus on patients when they need to.
Have you ever called to verify patients benefits? I’m sure you have and I am sure you have also been frustrated when the person one the other end of the phone is in India and can barely speak English. This is not a mistake. It is a tactic. Other parts of the verification process are designed to ultimately cost you time and money, frustrate you to the point where you “go cash”. There is the deductible family and individual, co-insurance/copay, allowable amounts, contracted amounts, in network, out of network, maximum benefits for a year and lifetime and so on. Hundreds of more combinations right? At the end of the call you think you know how much you might get only to find out the person gave you the wrong information. You have already submitted 20 claims, now what? This is no accident and it cost you at least 30 minutes in man hours to get the information. 30 minutes X $15/hour equals $7.50. It cost the insurance company maybe $1. They are kicking your butt. If it were $1 for you it wouldn’t be so bad. Some docs are also outsourcing this to India. This is one thing we help our clients do. This process is one of those that takes so many man hours that it just drains your staff and they are unable to focus on patients when they need to.
