3 Things You Need to Know About Working With Insurance Companies

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insuranceHealth care administrators are responsible for helping a medical facility run smoothly while it provides quality care to patients. Part of this job often involves working with insurance companies. After you get your MBA in Healthcare, what things can you keep in mind that will help you with this vital aspect of your career?

1. You Must Balance Quality Care and Financial Concerns

Helping patients to receive the care they need is a priority for health care administrators. However, you’ll also have to juggle a myriad of financial concerns. To strike this balance, you will have to negotiate with health insurance companies.

Health insurance companies, like any type of business, want to bring in as much money as possible while keeping spending to a minimum. Hence, they often favor facilities that charge less for medical procedures.

Carefully analyze the prices you charge for services and weigh that against how much those services cost. From there, consider the lowest offer you can accept from insurance companies for procedures.

2. You Have to Do Your Research and Prepare Well for Negotiation

Negotiating with insurance companies may be more difficult if you work in a relatively small facility. Becker’s Hospital Review, citing information from a professional at a health care consulting firm, says, “large health systems do not have problems with the pre-negotiation steps; it’s usually a community and regional hospitals that have a more difficult time because the people who negotiate payor contracts usually wear several different hats at the hospital and may not have all the software tools that can help model contracts.”

If you find yourself in such a situation, it is important that you conduct the proper research to arm yourself for successful negotiations with insurance companies. Understanding the dynamic between the health care facility and the insurance agency helps you anticipate obstacles.

3. Keeping Up-to-Date on Health Care Laws Is Vital

Depending on your specific role, you may be called upon to help patients at your facility understand their health coverage. Doing so means that you must stay abreast of any changes that occur to health care laws. This is no easy feat. According to an estimate from the Galen Institute, as of June 2015, about 51 changes had been made to the Affordable Care Act since the act first came to light.

Also, knowing health care laws is important because they may directly affect how you and/or insurance companies carry out business. Keeping yourself and the insurance providers you work with accountable for following federal regulations can mitigate misunderstandings and help you avoid the penalties that come with inadvertently violating a law.

If a lawyer works at your hospital — or if you have a lawyer on retainer — you can ask him or her to help you understand and comply with the ever-shifting regulations.

It takes time and practice to learn how to work with health insurance companies. By balancing quality care and financial concerns, preparing well for negotiations, and keeping up to date on health care laws, you can succeed at this challenging but necessary task.

Resources:

Artofmanliness.com, “Heading Out on Your Own: A Young Man’s Guide to Health Insurance”
NPR.org, “They Paid How Much? How Negotiated Deals Hide Health Care’s Cost”
Healthcare.gov, “Health insurance rights & protections”
GalenInstitue.org
BeckersHospitalReview.com, “The Ins and Outs of Successful Hospital Insurance Negotiations and Service Pricing”