Playing To Win At The Insurance Game

Author(s): 
By Neal Frankel, DPM

Who would have thought that when we finally went into practice after years of podiatry school and residency, we would be more dependent on third party payers for our existence than our patients? In fact, recent studies have indicated that, on the average, we spend one-half to one full hour per patient on paperwork and insurance matters. For many podiatrists to whom I have spoken, the “hassle factor” of trying to get paid from insurance companies seems to be the primary reason many of them are not happy with private practice.
Keep in mind this is a game of sorts. The insurers want to keep the money and we want to get paid in a fair and timely manner for our services. However, keep in mind that for every month an insurer can delay its payouts, it can make millions of dollars in interest on the money it still retains. It would be nice for us not to have to pay our rent and other office expenses every month so we too could make money on the money we keep. Unfortunately, we do not seem to be able to enjoy this same luxury.
It is amazing that most of the doctors I lecture to have never even seen the contracts they have with managed care companies and insurers.

Your managed care contract can determine how you are to be paid, when you will get paid and of course, more importantly, how much you will be paid. Many doctors do not even know which plans they are contracted with when you ask them. How can their office know if they are getting paid correctly or not if they don’t even know who is supposed to be paying them? Now many doctors are contracted through IPAs affiliated with their local hospital, but you still are entitled to go in and look at the contracts or at least see what they say.

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