What Do Health Care Providers Look For in an Insurance Company?

To some, this may not seem like important information. However, when considering what doctors you want to visit or what insurance you need, knowing all the information you can is important. You should know what your health care provider, from walk-in medical clinics to hospitals to individual doctors look for when choosing an insurance company.
Let’s face it, when the average person thinks of health insurance, they think of premiums and co-pays, whether or not the insurance is comprehensive or if additional cancer policies are needed. Pre-existing conditions, deductibles, and Cobra payments often never make their way into the thought process. Medical providers must take a serious look at the insurance they accept, although it may be at the opposite end of the tongue depressor.
Instead of worrying about having the money to pay for insurance, they have to worry about actually getting paid from the insurance. Everyone has bills to pay, even doctors. And don’t forget about hospitals which have millions of dollars every year to pay so they can offer you a service. And while some hospitals, especially teaching hospitals, do receive endowments, the bulk of the bills have to be covered by payments from insurance companies. While a co-pay they receive may help some with their cash flow, an office can not stay open without constant payment from their insurance companies. This means that an insurance company that doesn’t work well with the accounting office isn’t going to be very popular.
Needless to say, there are hundreds of insurance companies out there. To be able to cover a large amount of people, which in turns increases their profit margin, medical providers must accept insurance from many different insurance companies. While this means that continued cash flow occurs, and the associated profits as well, it also means that handling insurance claims becomes more difficult with each additional insurance carrier they support.
All expenses need to be paid for, from band-aids to suture needles to the stickers given to children for good behavior. To cut down on the confusion and amount of time to decipher, coding systems have been simplified. And while the codes used may be Greek to the common consumer, each code represents money to both the doctor/hospital and the insurance company. A common coding strategy that works with their process as well as other companies is one aspect that must be considered. While this used to mean they had to learn a different system for each company, as the health care industry grows, there must be compatibility between them all. Having software that will support multiple insurance companies does simplify the accounting job, but if insurance companies don’t adhere to a standard coding schema, that could reduce the number of health care providers that will use their services.
Overall, your medical providers have to be just as careful and picky when choosing to accept an insurance from their patients. Denied claims or late payments are annoying to us because of the other bills we have to pay. These are even more bothersome to your doctor as it can cause a financial crisis for their business. So, making sure your health care provider carries your insurance, or that you have insurance with a company your health care provider works with is of vital importance.