6 Things Insurance Companies Do to Keep from Paying

As we debate health care reform nationally, many would like to pit patients against doctors and vice versa.

Actually, it’s the health insurers we need to be reforming. As we learn how the insurance industry works, doctors have begun to share with us some of what insurance companies do to make it difficult for doctors to provide proper care.

1. Insurance companies change what they will pay for.

Insurance companies routinely change what services they will reimburse. This list can change yearly. It is driven by insurance company costs and not by medical necessity as determined by the doctor and the patient.

2. Insurance companies specifically look for reasons to deny recommended services.

Insurance companies have physicians and nurses on staff that can deny services. The person reviewing the procedure may not even be familiar with the medical procedure (for example, a psychiatrist reviewing the records of a surgeon).

3. Insurance employees get bonus compensation when they save the company money.

Since it pays to deny care, the insurers can pay bonuses as incentives to deny coverage.

4. Insurance companies discount payments for surgery and other procedures.

This is a process called bundling which pays surgeons steeply discounted rates for multiple procedures.

5. Insurance companies make a bigger profit by delaying payment to doctors

A study showed that an insurance company can make as much as $84,000 in bank interest rates each day they pay a claim late. An average clean claim (with no errors) should be paid from 14-30 days after it is submitted by a doctor’s office. The average claim is paid anywhere from 30-45 days. Some claims, after multiple appeals, can take up to a year to be paid after the service was given.

6. Insurance companies can ask the doctor for reimbursement of paid claims indefinitely.

A doctor has 120 days to submit a claim, after that time he/she may not submit a charge or charge the patient. However, an insurance company can ask for reimbursement with no time limit.

Doesn’t it make you wonder how so many people are duped into opposing health care reform? It’s time patients and their doctors’ decisions come first instead of being dictated to by the insurance industry.