Medical Billing – Insurance Carrier Perspective

Everybody has their own point of view on every subject. In this world, our point of view, at least in our minds, is the right one. Well, that is no different in the world of medical billing. The patients think they should be paid for the claims, the medical billing companies want the patients to get paid for their claims so they can make their money and certainly the doctors want the patients to get paid for their claims or they’ll go to another doctor. But what about the insurance carriers? It seems that they are the last people who want to pay claims. Well, this is for a very good reason. While everybody else is getting paid, the insurance carriers are paying out.

Sure, these carriers also get a monthly premium from somewhere, whether it be from us poor workers if they are a government agency or from the patients themselves if they are a private insurance company. But the truth is, especially with government run agencies, the money coming in is far less than the money going out. That is why the United States Medicare and Medicaid programs are in such trouble and in danger of going broke. Medical costs are skyrocketing because doctors are charging more and more for services, but the common worker doesn’t make enough to put into the fund to make up for these increases.

Medical Billing

As for private insurance companies, they have an even bigger problem. Whereas the government agencies can work at a loss because they’re non-profit, the private insurance companies have to show a profit to their stockholders. Otherwise, the company goes out of business. This makes it so that they are even more reluctant to pay out claims. This however, is a real catch 22. See, the people they are paying the claims to are the people who are providing them with their income in the form of insurance premiums. So if they’re not being paid, they’re going to take their business elsewhere. Talk about a no win situation for a private insurance company. That’s why so many of them have gone out of business over the last 30 years. Even the big giant Prudential has had its problems.

Because of these concerns, the insurance carriers have to be very careful about paying out claims. They have to research each one carefully to make sure the claim itself is legit. This will ultimately slow up the process, which is what medical billing companies and patients end up complaining about. But the truth is, there are a lot of bogus claims out there and if these insurance carriers paid out on all of them, they’d be broke sooner than you can say “I’ve fallen and I can’t get up”. So it is understandable that these insurance carriers run their businesses the way they do.

The point of this article is to give these carriers a little slack if you’re a patient or a medical billing company. Remember, without them, you wouldn’t have a job and would have to pay for your medical bills out of your own pocket.


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