Chiropractic Billing Secrets – Tactic #1 – What Insurance Companies Don’t Want You to Know
In most cases insurance companies have 45 days to process the claim once they receive it. Keywords, process, and receive. Remember, they make up to 50% of their profit from interest earned on your money. Not just premiums they have collected from patients. The insurance company strategy comes in four basic flavors.
- Delay claim submission
- Prevent claim submission
- Prolong the “processing” time.
- Take the money they paid back from the doctor.
Now we know their motivation. If you look at the chart below it is pretty obvious. What tactics to they use to make it happen?
Tactic #1 – Gain The Power to Make The Rules
In a free market power is gained in two main ways.
- The first way is a Monopoly. The government is very concerned when a monopoly occurs. If you remember Microsoft spent millions defending itself in court when it was accused of having built a monopoly. At the time almost every computer in the country was using a Microsoft operating system. A monopoly occurs when there is only one supplier of a good or a service. When this is the case, that supplier sets the price. Since there is no competition they can unfairly raise the price. When the good or service is something that is a basic need, people can be taken advantage of. For this reason the government steps in.
- The second and less known way is an Oligopoly. In short it is a monopoly in reverse. Rather than one supplier there is only one buyer. If you were the only one paying for a good or service you would dictate what you would pay. 70% of insured who live in the US are covered by only three insurance plans effectively making them the only buyer. They dictate what they will pay the doctors, how long it will take to pay, and even shift the burden onto the patients. They get to make the rules. The government is not as likely to step in the middle here and it is difficult to prove an oligopoly exists. They do this by consolidation. This is the reason we see insurance companies buying each other up all the time.