Insurance Contracts… no one who hasn’t passed the bar exam ever really reads an insurance contract from start to finish. Unfortunately too often we realize that it might not have been bad idea to do just that. Never is this more true than when it comes to contracts with insurance companies.
Insurance companies are notorious for producing purposefully vague contracts by using terminology that is terribly unclear, terms like “usual and customary”. Here’s one definition of “usual and customary” from businessdictionary.com,
“Denotes the base amount that is treated as the most typical charge for a medical service when provided in a specific geographic region. Third-party payers such as insurance carriers and employers implement these fees to conclude the amount to be paid on behalf of the enrollee, for services that are recompensed by a health insurance policy or plan.”
In other words an arbitrary amount than can and will change based on undisclosed criteria. If you sign a contract where the reimbursement is based on “usual and customary” odds are you will be paid far less than you’re anticipating.
What to Do?
Before signing an insurance contract request a fee schedule for 15 – 20 of your most commonly used CPT codes including hearing aid codes. This should eliminate the “surprise” of a significantly lower than expected rate of reimbursement.
It is also possible to negotiate the terms of your contract with an insurance company. Contact the insurance company representative (yes, you have one) and explain that you would like to participate with their XYZ Plan but would like the following reimbursement…for the following codes.
More importantly, if you either don’t understand what you’ll be paid for your services or feel their reimbursement will significantly impact your bottom line, don’t sign the contract. Often times the fear of being excluded creates the compulsion to join against your better judgment. Just remember, it’s ok to ask for better terms or to simply decide not to participate.