Insurance Reimbursements? Not Exactly a Pot of Gold

A recent post from a member advocate in our AdvoConnection Forum asked if any of our members have experience with working with self-funded insurance to offer patient advocacy services. Wouldn’t that be a great way to establish a big client, with a pot of money that was ready to be paid to private patient advocates?

There were no replies to the question. That doesn’t mean that no one has experience with these reimbursements. It just means that no one replied to the question. BUT – the reasons no one replied may be a version of the following:

Want to make your life a living headache? Seek reimbursement from insurers – any kind of health insurers – for your work.

That pot of money is held tightly in insurers’ grips and is being rationed already to the people who CAN access – but hate that they have to.

Over the years, I’ve spoken with plenty of people who work in reimbursement models, both with private and public payers. Doctors, nurses, hospital administrators, psychiatrists and counselors, even some case managers – they all tell me that if they had any way of dropping out of the system, of just having their patients / clients write them checks or hand over a credit card, that’s what they would far prefer to do. They employ half their staff to do nothing but file paperwork and try to recover money they are owed.

Start with the paperwork. Next, step up to the medical coding system. Tens of thousands of codes. Now submit that paperwork and wait and wait and wait – for months. Then be rejected. Why? Because you made a mistake in the paperwork. Resubmit. Wait months and months more. Finally – six or more months after you delivered the service and billed for it – you might get paid. Even then, it will be a fraction of what your services were worth. WHICH, by the way, you had to negotiate last year, and will have to renegotiate this year, etc., etc.

That’s no pot of gold. That’s Fort Knox. Even those who are part of the reimbursement system have rusty, dull keys that only work part of the time.

[It’s ironic that some of the people who have been working in this reimbursement system are now opting to remove themselves from it (see concierge practices) while others (some patient advocates and health coaches) are trying to wrangle their way in.]

Think of the efforts that go into that. Think of the amount of time it takes. Do you want to devote half your time to chasing paperwork? It’s time, instead, that you as a patient advocate could be using to help patients, or to learn more about your craft, or could put toward speaking to groups of potential clients or other forms of marketing.

People who can, simply, write you a check.

Among our Alliance membership, there are some folks who have sought reimbursements in the past. I haven’t heard of successes yet – but would love to. This post is not intended to dissuade anyone from developing a reimbursement system that works!

I don’t want this to be a one-sided conversation. But so far, all I can think of is the headaches it would cause.

Thoughts? Ideas? Please post them here – or in the APHA Forum.

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