How to Settle Higher Reimbursements: The Missing Link Is to Leverage Relationships

In our experience, the claims industry lacks a crucial aspect of business: Relationships. Healthcare providers rarely speak directly with insurance carriers, and when they do, a sense of cooperation seems to be missing. There is simply too much ‘distance’ in between healthcare providers and insurance carriers.

To imagine providers and carriers building a relationship together is a bit farfetched. At the core of the exchange is a negotiation. Both sides try to settle the claim to the benefit of their respective employers, so from the beginning there is a barrier. Plus, due to size of the industry, rarely does the same adjuster work with the same claims representative on more than one claims resolution.

Communication Is Key

As the industry currently stands, healthcare providers rarely communicate directly with insurance carriers. The reason? They’re often wedged apart by third party Plaintiff’s Attorneys and Revenue Cycle Management companies. Like a translator, the middleman attempts to manage a ‘conversation’ between the hospital and the insurance carrier. The issue arises, however, when the motives come to light: Plaintiff’s Attorneys and Revenue Cycle Management companies value a big payout from the insurance carrier and healthcare provider respectively, rather than a cooperative and positive outcome for both parties.

Continue reading this article on the ClaimTECH blog here:

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