What do I need to know when working with health insurance plans?

What do I Need to Know When working with health insurance plans?

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Doctors need to be informed before they accredit to avoid falling into traps or mistakes with health plans!

It may be worth!

health plans can be a big move in the career of a health professional. Doctors beginners, inexperienced and with little prestige, who are opening their own office, may have a jump in the number of patients with the support of the plans. But there are some things that the professionals who want to join this business model need to know not to fall into traps and become companies hostage.

Accreditation to a health plan can be very good for you, professional and can be catastrophic, know this. It all depends on how you will deal with the company and with all the features of this branch of service in medicine. Here are some important things you need to know about this world.

health plan definition

What is a health plan? According to the National Health Agency (ANS), health plans are services offered by private operators in order to provide hospital and medical care. Remember that health plans only exist for the State’s failure to ensure that all citizens an efficient health care, which is right guaranteed by the Constitution. In Brazil alone, there are about 2000 operators of health plans, thousands of professionals and approximately 42 million people covered by these companies.

To work for a health plan, the doctor needs to accredit the company as a service provider. With this association, it is available in the medical guides operators, is forwarded by the plans, it serves patients and receive the fees through the health insurance company, without ever receiving transfers made by the patient, which periodically conducts the payment to the company as the contract between the parties.

Advantages, disadvantages and preventing problems in health plans

Answer by health plans, on the one hand, attracts more patients because the name on the medical guide the company makes your office become more known and requested. On the other hand, the professional receives less per visit or procedure than if faturaria would meet in a particular way. This is how the company takes part of the profits obtained with the mediation between patients and service providers.

Be accredited to a health plan assumes full acceptance by the professional of an employment contract proposed by the company. It is imperative that the doctor has knowledge and full understanding of what is established in the contract clauses not to get into business without being aware of their bonuses and burdens. For individuals, normally the required documents are: CCM or ISS, CNES, CRM, Charter of Health Surveillance, Business License, resume, diploma, social security number, bank account voucher and data service site as address, zip code and telephone.

However, we know also that companies can not put everything you want in terms of their contracts. The ANS establishes a series of rules in these service agreements between operators and physicians.

Tooth them, establishes that health plans can not pay doctors less than the defined by the Professional Convention (CFM and CRM) can not offer less value to the already previously signed and can not interfere with the secrecy or diagnoses of doctors, offer consultations packages or bar procedures for economic reasons. The Agency also establishes a list of medical services to which the operators have the obligation to provide full assistance.

Bureaucracies and transfer payment

Also note that payment will be received by the company after the delivery of TISS guides to companies. This guide is a document that details procedures performed on the patient and their costs. You, doctor, should not cause the patient to sign a blank tab. With the duly completed guides, it is necessary to systematize, print and forward for the company that assesses and payment.

But also know that depending on the company, this analysis guides and the payment can take, so if program. Science has yet what are the “glosses”. This procedure happens when the operator disagrees with what is recorded in some TISS Guide and decides he does not hold the payment. You, professional, have the right to appeal in the given time to recover the transfer of money.

Even before making contact with the health insurance companies for details of each contract, make an internal analysis of economic contexts and their own career. Evaluate, in fact, if you need an accreditation to any health plan and plan so that everything works out for you.

Regardless of your decision, it is important that the health professional sees his office as an enterprise that need strategic attention. You have to invest some of your time to plan actions for dissemination of practice and increase the quality of care.

Invest in a good management can impact on results rather than the office offers you every month. So it is important to start thinking about investing in technology to centralize all office processes – administrative, financial and strategic – in one place: a management software and marketing for offices.

In  iMedicina  we offer this possibility! Learn about our proposed visit to  our website  and better understand how to computerize your office and attract new patients!

Enjoy this text and want to know more? Stay on our blog and also read other articles on medicine!

To delve further into the matter and find other tips for the financial management of his office, take a look at the items we prepared:

  • What you lose without an accurate control of the office’s finances?
  • Find out why your office needs URGENT a financial forecast
  • Complete Guide to improve the financial management of the office
  • Best practices in the financial management of the office
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