The Health Care Payers That No One Has Ever Heard Of

Go Away, I’ve Never Heard of Them!

What must we do when a patient presents an insurance card that lists no insurance company and no PPO network? We must reject them, the bible says so!

The Health Care Payers That No One Has Ever Heard Of

By Bill Rusteberg

There are health care payers in town that no one has ever heard of. Who are these payers and how do we handle them? After all, as insurance clerks, we are charged with verifying patients have insurance we are contracted to accept.

We have our bible, a handy three ring binder that lists all the insurance companies and/or PPO’s we accept.  What must we do when a patient presents an insurance card that lists no insurance company and no PPO network? We must reject them, the bible says so! “Sorry, we don’t accept that insurance!”

Who are these payers and is this really insurance?

They are employers who have found it difficult if not impossible to continue health care benefits for their valued employees. With their financial backs to the wall, they have left the status quo world of managed care and instead have adopted a transparent payment system they believe to be fair, reasonable and defensible.

They pay more than some of the other “recognized” payers we accept, like Medicare. And they pay quickly.

“Really? If I had known that maybe I could have called in my business manager for his advice. If this payer who we have never heard of pays more than we get now from Medicare for example, why would we not accept it?.”

Educated plan members covered by a payer you have never heard of are adept at soothing ruffled feathers.

“Do you take Medicare” they ask. “Why yes, we do.” “Great, you are really going to like my insurance because it pays more than Medicare! Call the 800 number on my I.D. card and they will explain how my plan works and how much you will get paid for today’s visit.”

These payment strategies are gaining traction in the market.

Wow, that’s really interesting. If we could just find a way to handle this at the point of service, electronically, with claim adjudication and payment transactions done at the same time, that would be great!”

Well it just so happens……………………………..

 

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