Best Practice Management
Reassessing Insurance Contracts – Mission: Impossible?

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Lynn Homisak, PRT

Practice Management December 19, 2019

The Assignment: Your mission, Dr Phelps, should you choose to accept this assignment, is to first obtain copies of your insurance contract[s] for review. If these elusive documents are ‘maybe/probably/somewhere’ filed away in your records, accessing them may involve finding the person who holds the “keys” to that administrative paperwork at each of your contracted insurance companies. While this might seem like Mission: Impossible, it is necessary to the financial health of your practice to stay the course.

The Cautionary Signs: How do you know if your contract needs to be re-negotiated? Ask yourself:

• When did you LAST review your contract? THAT long ago, huh?
• Have you compared your private payers’ fee schedule with Medicare’s? Is it lower?
• Have your private payers raised their fees since you’ve been on the plan?
• Have all your practice expenses (including malpractice) raised exponentially, except your plan insurance reimbursements?

The Briefing: Jumping off plans that do not serve you well is an option. So, too, is evaluating your contracts to make an informed decision moving forward. Your call. Your contracted insurance carriers hold the originals or at LEAST copies of them and since you are party to the agreement, you have a legal right to a copy. This is a cut & dry request; a task that can be delegated to qualified staff. Following are some simple and effective steps to help guide them through the process:

• Call the Provider line or Physician Relations and ask to be connected to the department that handles contracts. [HR or Legal Department]
  Be sure to record the necessary contact person’s name, phone # + extension, email, fax. Repeat for accuracy in case you somehow (roll eyes) get disconnected. Also, have your Insurance Identifying numbers handy so they can easily identify your practice.
• Once connected to the appropriate department/individual, introduce yourself and again state your request; this time with more specificity.
  STIPULATE: you’d like a SIGNED COPY. Remember to DOCUMENT the call, including date, time, who you spoke with and conversation details. Accept no flimsy excuses if they claim these are unavailable and if they say something you don’t understand, ask for clarification.
• If an online request form is requested, be prepared to have the following information available:
  Practice UPIN #, Practice Tax ID #, Practice address, Physician[s] name[s] and an approximate date of contract if actual date is unknown.
• If they require a written request for this information…
  - Make sure to get the person’s name to whom it should be directed and the proper address details. Include all the same relevant information [identifying numbers, UPIN and Tax ID #s, approximate date of contract and the reason for your request.] Make copy for your records and send original correspondence via certified mail, return receipt requested.
  
  - Ask if you can scan and email it to expedite the process. Don’t forget to get email address and REPEAT it back for accuracy.
• Find out when you can expect to receive this contract document.
  Will it arrive by mail or email? Provide DIRECT/PRIVATE email address if they agree to transmit it electronically.
• Ask what additional information they will need from you now to avoid any delays.
• Keep track of your request and be sure to follow up. [If you don’t care, don’t expect them to.]
  If you do not receive contract documents within their stated time period, send a copy of the original request along with a demand letter, “Please immediately address this matter; mail/email a copy of the requested contract within [X days] [or exact date] to avoid further action.” Send this follow up request also via certified mail, return receipt requested.

Mission Accomplished: As you receive the contract copies from each insurance company, review carefully to determine which third-party payers you want to remain with and which [if any] to opt out. If you haven’t monitored their reimbursement trends enough to analyze these numbers, it would behoove you to sift through recent EOBs in order to come to a decision regarding your next course of action.

As always, should you or any member of your team cop out or surrender, SOS will disavow any knowledge of your actions. Good luck, doctor.