(originally published November 10th, 2005)

I went to a seminar yesterday presented by a speaker from Seattle, Judy Veasie, who’s also the editor for the healthcare receivables newsletter for Aspen Press; they’ve printed a number of articles written by yours truly. I was proud because I got her here, and she was very good. The overall presentation was on how medical entities can get paid sooner from insurance companies, and some of the tricks of the trade that she’s discovered over the years.

One thing she said I had never thought about before, but it’s something every consumer who has a health insurance plan through an employer should consider. She stated that her organization keeps track of how insurances pay and who the employers are, and when they start having continuing difficulties they contact the employer to let them know how the insurance company is, or isn’t, paying on their claims. Each year, employers get with health insurance plans to try to find plans that take care of their employees, and when they hear continuing bad reports on their insurance policies, they tend to bring that information back to the insurance companies as complaints.

Another part of this is that employees need to go to the human resource departments to complain when it seems their insurances aren’t covering their bills without problems. Many people seem to think that, whenever claims aren’t getting paid, that the hospital, or physicians, are the ones at fault. Sure, sometimes that’s the case, but not always.

Insurance companies will find interesting ways to not pay claims, and many times, they’re invoking some reasons that are patient related, and not always true. Some examples of this are: the claims weren’t coded correctly; we’ve requested additional information from the patient/guarantor; in processing because the premiums haven’t been paid by the employer. Not that these may not be legitimate, but every once in awhile an insurance company gets called on a lie that some customer service representative has stated; our speaker told about not only recording phone conversations, but having the patient being a part of the call so the patient could hear what the insurance company said first, then dispute it right then and there and have a customer service representative attempt to do a quick about face.

Patients who have employer based insurance do have some powers they may not have known about. I’ve just given away a nice secret.