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4 Questions You Need To Ask Your Health Insurance Company

As a small business owner, you probably rely on the services of other organizations to accomplish a range of tasks, services and other duties. Your health insurance broker or policy provider is one you expect has your best interest in mind. The reality is, they may not, especially when it comes to premium and individual claim costs.

With all your other responsibilities, you don’t have time to keep tabs on everything your health insurer does, however, there are some key questions you need to ask in order to effectively evaluate just how much they are working for you:



What does the plan cover? 

Many health insurance providers add in coverage for care you and your employees may never need. By providing an everything-but-the-kitchen-sink plan, insurers are able to increase the overall cost of the policy, meaning you and your employees are paying for benefits that don’t match their needs. Alternatively, using a third-party administrator (TPA) can help you secure group coverage that fits the needs of your employees, which can help you keep your healthcare-related costs down.

How do you negotiate costs? 

Healthcare is expensive. While some insurance companies claim to negotiate lower costs on your employees’ claims, they are not revealing the entire truth. The discounts are taken from the astronomically expensive costs doled out by the hospital or physician’s office. With a TPA and other services, there are many other ways to negotiate costs.   Multiple negotiation strategies keeps claims in line with more realistic pricing. 

How do you audit medical bills? 

Health insurance companies have little transparency when the final bill for medical care comes in for a claim. Generally, they do not ask for details related to costs or challenge prices. Instead, they pay their portion and turn the balance over to your employee. TPAs have the resources and knowledge to help your employee check each bill to ensure there is no double billing for equipment or health care services. They will challenge prices for services that are beyond "reasonable and customary," substantially reducing patient bills and keeping your costs related to medical claims down.

What type of customer service do you offer?

With most insurance companies, you and your employees are a number in a huge system. You are at the mercy of the representative who takes your call when you have a question about your policy or have an issue with a claim. Navigating through red tape and other administrative obstacles can be frustrating and can lead to paying for unnecessary expenses. With a self-insured health plan managed by a TPA, each person’s needs can still be handled with personalized customer service to ensure issues are resolved and costs are minimized.

Asking these questions of your health insurance carrier or broker can expose issues you may not have known existed. With a self-insured plan managed by a third-party administrator like GMS, you have more control over the type of insurance you need. Ultimately, this can cut your healthcare costs and enable you to provide better, more customized coverage for your employees and their dependents.


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