7 Tips to Getting What You Deserve from Your Health Insurance

Providing excellent health insurance to your employees is the goal of most law firms. The problem today is that even after spending lots of firm (and employee) money, health insurance claims are not always paid properly. This leaves your employees to shoulder hard-dollar costs — not to mention the hours of wasted time fighting with insurance companies.

The best health insurance brokers understand their service role in assisting their firm’s employees with these problems.

Here are seven tips from our internal claims fighting champions to get what you deserve from your insurance companies:

1. Team up. Your health insurance broker often has systems and teams already in place to fight for you, so don’t assume that they can’t help you — just ask. In some circumstances — especially if you are looking for a combination with medical concierge — consider engaging an outside company like Compass or Health Advocate. They can assist in the medical planning (strategy on treatment plans), as well as digging in and reviewing each medical provider’s bills until they are fully processed by the insurance company.

2. Communicate from the onset. Many claim problems are a result of your employees not understanding their benefits. A good open enrollment meeting and written communication can alleviate misunderstandings later. On the annual renewal process, spot common misconceptions or challenges and be proactive about those specific issues.

3. Avoid the game of telephone. We often find a breakdown in the claims submission process from the medical providers. A comprehensive review of how the claim was submitted is often the method to detect incorrect charges. Lately, the biggest errors are coming from the medical provider inputting the wrong Current Procedural Terminology (CPT) code, or incorrectly miscoding preventative as a regular service leading to a much higher employee cost. (CPT is a massive database of all medical procedures to which insurers base their reimbursements.)

4. Wait for the dust to settle. Do not pay the bill! It is critical to wait a minimum of 7 to 10 days from the date of service to allow for the insurance company to process claims. Many times medical offices and hospitals will request from your employees a direct payment (sometimes huge sums) prematurely. In today’s climate where some employees have high-deductible plans, medical providers are sometimes requesting thousands of dollars up front at the point of service. If at all possible (even if you have a high-deductible plan), push to allow the insurance company to process the claim before you make any payment.

5. Plan for everything. Call your insurer to ascertain if there are ANY protocols that you must follow BEFORE treatment. Although insurers have shortened the list of procedures that require precertification, the penalty for not following their procedures — like precertification — are becoming more severe. The good news is that contacting someone from an insurance company “live” — be it over the phone or via live chat — has become easier over the past few years.

6. Beware of hidden providers. Even with your planning, you must be on the lookout for extra charges from hidden providers. With all hospital admissions, there are teams that will provide services during your admission. While you likely know your treating physician, there are many others who work in a hospital environment that are billed by the hospital (paraprofessionals, hospital labs, nurses, etc.). Most of these are billed and covered by the facility. There are other providers (aka hidden providers) that you usually have no choice in selecting, such as the anesthesiologist, that may NOT follow the hospital billing arrangements. These providers will sometimes attempt to bill you at much higher levels than your insurer provides. With enough wrangling, they will usually accept the fees provided from your insurer.

7. Add up the paperwork. On complicated claims like a hospital admission, it is important to make sure that all of the claims have been processed before tackling the problems. It is tempting to deal with each bill/explanation of benefits (EOB) as they arrive; however, it can lead to duplicate or overpayments that are difficult to undo after the fact.

Providing robust health insurance plans can be a very good method for retaining your best employees. The best firms are learning from their claims’ history to keep upping their game to minimize claim disruptions and demonstrate their desire to be the employer of choice.

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