HOW LONG DO INSURERS TAKE TO PAY?

How long do insurers take to pay after I’ve done my paperwork?

It seems that the answer should be on the front page of every insurance company site, but unfortunately, the reality is not like that.

THE SHORT ANSWER IS: “IT DEPENDS”

We know that it is a disappointing answer, but the reality is that it depends on many things. The date on which the procedure was carried out if there were tabulations, the specialty of the doctor, the amount that was charged, the insurer with which the procedure was carried out, and in some cases, the mood of the person who keeps the accounts in the private insurer. In summary: It is a gamble to know how long it takes for insurers to pay.

At Pagomed we want to increase the tabulations of doctors and improve the way they are paid, and a key point is to standardize payment dates.

If you manage to get through to someone at the insurer after going through the switchboard and being redirected to every office that has the insurer you spoke to, you’ll probably get a response like, “Your receipt was wrong.”

This is the best case, and that was if you were lucky and someone searched their database for your name among millions of doctors nationwide to find the exact cause. 

In many other cases, everything boils down to a cordial: “I’m going to send you an email so you can follow up”.

You never found out, you never knew when they made that decision, you don’t know if you’ll be able to collect that authorization letter after so long, and you’ve wasted too much time getting nothing. In some cases, many doctors prefer to write it off.

DID YOU KNOW THAT A DOCTOR LOSES UP TO $150,000 MXN ANNUALLY IN LOST FEES?

Insurers follow a very strict process and any error in the forms they receive from medical providers is enough to question the legitimacy of the payment and reject it.

Each insurer is different and each of them has a different process and format. So: what can a doctor do to collect his fees without wasting hours reviewing forms or letting his bills drift?

Today’s solutions are a bit medieval for our liking. We can have a secretary and drown her in paperwork. The time it takes for her to complete all the forms is time that is reduced in activities that could increase the number of patients who visit us and therefore income.

Hire an outsider and pray their bookkeeping and organization help us get our money. Many times these people cannot provide receipts, so there is no way to deduct this extra cost.

We can try to play David against Goliath and do things over and over again to suit the insurers in order to one day receive our fees. Of course, if we do this it is because we have already made up our minds that it will take us at least 4 hours a day to complete the format of our receipts.

IF WE OPTIMIZE THIS TIME TO GIVE MORE CONSULTATIONS, WE COULD HAVE AT THE END OF THE YEAR: AN ADDITIONAL $208,000 MXN.

(In the time that goes into discussing with the coinsurers, you could make 8 extra consultations per week * $500 Mxn per consultation * 52 weeks a year)

Then what do I do?

To improve the payment time and be more clear about how long it takes for insurers to pay; The first thing to do is retrieve all the letters of authorization that we have not received or that have not been paid to us.

We can do it ourselves, or we can hire someone, but Pagomed was born with the aim of making this process faster and it is also deductible.

Then follows the process we are used to. Go to the portal or mail, or process each insurer and complete the request for payment to medical providers.

We have to have our receipts made with the requirements not only of the SAT but of each insurer. In the order in which our receipts are issued, your address, date, semi-colons must match the formats requested.

This is already intimidating, we know because our clients constantly share with us their horror stories and the number of problems they have been through to realize that something has already gone wrong and they could not collect the money for which they already worked.

KNOWING THIS, WE DEVELOPED PAGOMED IN ORDER FOR DOCTORS TO RECOVER THEIR FEES IN LESS TIME. THE PLATFORM AUTOMATICALLY CREATES THE RECEIPT AND COMPLETES THE PROCESS WITH THE FORMATS THAT EACH INSURER REQUESTS.

The doctors within the Pagomed team have experienced first-hand the consequences of losing fees due to poorly executed formats. All of our language, customer service, and processes revolve around the most common complaint among health care providers. 

“It seems that they are doing me the favor of paying me”

We hope that this article will help you organize yourself better and know how long it takes for insurers to pay