Delaying & Stalling
What to do when insurance companies say…
- “It’s being processed”
- “We never received it”
- “We need more information”
What to do when they…
- Ignore you, or never respond with anything
- Write poor language on the explanation of benefits statement that splices your relationship with your patient
- Play games with you
Reducing Payments
What to do when insurance companies…
- Pay you less than what was agreed upon
- Say your fees are “NOT USUAL, CUSTOMARY, OR REASONABLE”.
- Say you owe them money.
What to do when the attorney…
- Tries to get you to discount your bill
- How can I collect the full amounts?
- How do I better negotiate with attorneys?
- Should I charge for medical record requests? How much?
Denials
How to get paid when insurance companies deny payment with the excuse…
- “It wasn’t medically necessary”
- “You filed untimely”
- “We paid the patient. Go collect from them.”
What Insurance Companies Don’t Want You to Know About HMO and Out-of-Network Patients
- How do I see HMO patients if I’m NOT contracted?
- How much should I charge?
- I do have an HMO contract, how do I increase my pay?
- How do I increase my reimbursement?
- Why saying, “We don’t take that insurance” can kill your business.
- Do I have to verify benefits with EVERY patient?
Most private practices lose thousands of dollars each and every month, if not more, because they are unaware of insurance company tactics and how to handle them. Also, poor billing/collection procedures, inadequate tools, and lack of follow-up add to decreased reimbursement and increased struggle.
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