Working with the top insurance providers in the country is an important part of running an addiction treatment business. Each company handles their billing differently.
Slowly building relationships with employees at each company over time is the “gold standard” approach for managing tricky claims and other sticky billing issues with the top 10 insurance companies for addiction treatment.
But what happens when your staff doesn’t have the capacity for building those relationships? What if you have a lot of turnover in the billing department and not enough continuity to keep those relationships going?
Today, we’ll talk about the most efficient and time-saving ways to get the top 10 insurance companies to cover care for your patients, with or without game-changing relationship building. Read on for our best tips and tricks for “playing nice” with the biggest players in the game.
Who Are the Top 10 Health Insurance Companies in the United States?
First, let’s identify who we’re talking about when we talk about the “top payers” in addiction treatment. The top 10 insurers in the United States by size are:
UnitedHealth Group
Anthem
Aetna
Cigna
Humana
Centene
HealthNet
Wellcare
Molina
Magellen
UnitedHealth Group is the largest payer in the country with a membership of 49.5 million. Anthem follows closely behind UnitedHealth at 40.2 million. Aetna trails behind in third with a membership of 22.2 million, followed by Cigna at 15.9 million members.
By law, they all have to provide medically necessary behavioral health services, including addiction treatment. You’ll run into these companies again and again in your billing department.
Now, let’s look at a few smart tips for dealing with them efficiently.
Tip #1: Do Your Due Diligence
VOBs and Utilization Reviews are an absolute must, and learning how to do them properly—and thoroughly—will pay off handsomely.
We’ve written extensively on how to make these processes run like clockwork in your organization. Check out some of these awesome posts to learn more about how to master these billing department beasts:
Stop Struggling With Addiction Treatment Utilization Reviews in 4 Easy Steps
How Verification of Benefits (VOBs) Can Make or Break Your Addiction Treatment Center
3 Secrets of Efficient Insurance Billing for Drug Rehabs
Tip #2: Documentation is a Must
The old adage is true: “If you didn’t document it, then it didn’t happen.”
Insurance companies base their reimbursements on your documentation. If your claim denial rate (you’re tracking that KPI, right?) is nudging higher and higher, it’s time to take a look at your documentation process. This can mean retraining staff to take more complete, more accurate notes. It can also mean overhauling your software so that it automatically requires all of the information needed before the clinician can move onto the next screen.
Under the Affordable Care Act rules, proving medical necessity for each one of your services is paramount. Make sure your documentation spells out exactly what that means for each patient.
We’ve written about this topic here a lot too. If you feel like you need to brush up on your documentation chops, check out these helpful posts:
What You Need to Know About ICD-10 Codes for Addiction Treatment Billing
How to Make a Perfect Addiction Treatment Biopsychosocial Assessment Every Time
4 Ways to Improve Your Behavioral Health Center's SOAP Notes Today
Tip #3: Leverage Other People’s Relationships
Building relationships with staff at insurance companies is a long, difficult process. It’s also a highly human-intensive one, that’s very dependent on the two people involved—your staff and the payer’s staff. You need highly competent (and expensive) staff to get the job done correctly. And you need to retain them long enough to make the investment worth it. A solid, useful relationship won’t blossom overnight—it will take many points of contact to build trust and rapport between the two parties. Once you’ve reached that sweet spot, resolving difficult claims becomes a matter of a simple phone call. Until you’ve reached that point, though, prepare for a lot of bureaucratic frustration and failure.
Our suggestion? Leverage other people’s relationships instead of trying to DIY one in-house. At BehaveHealth, we have working relationships with all the major insurance companies because we deal with them on a day-to-day basis. Name any one of the top 10 insurance providers: our staff knows their staff. Simply put, we’re able to get things done at the major insurance companies that it takes independent companies years to figure out how to do. Why build your own relationship network from scratch when you can piggy-back on one that’s already been built for you?
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You’ve got nothing to lose. See why more and more addiction treatment providers are making the switch today. We specialize in making every part of your business—from billing, to clinical operations, to documentation—run smarter. Claim your free trial now.