Important Factors Health Care Providers Look for From an Insurance Company

Most people won't even consider this a topic for discussion, but when you stop and think about it, it could be one of the most impactful topics in the health care industry. What do health care providers like hospitals, doctors, dentists, psychiatrist/psychologist groups, etc. look for in 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 having to worry about paying out monies for health insurance, they have to worry about being paid. 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. And while co-pays may help with up-front cash flow, there's not a doctor's office anywhere that can afford to stay open without constant throughput from 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.

In order to cover all the expenses, every single band-aid and suture needle has to be accounted for and billed out. To cut down on the confusion and amount of time to decipher, coding systems have been simplified. While most people won't be able to read the coding system, it is the way communication happens between the doctor/hospital and 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.

All in all, health care providers have to be just as careful about choosing insurance companies as we do. 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. It is very important to make sure beforehand that your doctor accepts your insurance. If not, you will need to find one who does carry it and that sometimes means starting over from scratch with a new doctor.