Why should not I pay for health insurance in my office?


Why should not I pay for health insurance in my office?

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Health plans are binding contracts for service. They are offered by private companies for people seeking assistance and safety in health care, and at the same time want to avoid unforeseen expenses with medical expenses. What appears to be a solution to save the pockets of patients and at the same time ensuring a full schedule for physicians actually has been controversial target that leave both sides dissatisfied.

According to the Medical Demography report developed by the University of São Paulo (USP) with the support of federal and São Paulo Board of Medicine (CFM and Cremesp) in 2015, 25% of Brazilian physicians do not meet health plan. And among the 75% who accept covenants, the space on the agenda facing the care plans has declined in relation to the time reserved for private consultations. Why, then, many professionals are leaving the health plans, and why it is not advisable to meet covenants?

Low pay for health plans

The Brazilian reality of asymmetric data reflect the agreement of business policies. While beneficiaries criticize the constantly rising tuition and reduced benefits, the health professionals complain they do not receive adequate remuneration.

In fact, the main reason of complaints of physicians in relation to health plans is just the amount paid for consultations and care, which is much lower than the market value. Covenants pay an average of R $ 30 to R $ 60 reais per visit to a professional who has invested six years of college, 2-6 specialization and residence, and must be constantly updated on the news in your area attending conferences, courses and specializations. Moreover, often the health plan does not pay extra for the “return” of the patient, a common practice in certain types of calls.

This insignificant amount makes the professional is obliged to meet from 4 to 6 patients per hour to receive a decent return later in the month and pay the expenses of the office. Another common way out is to extend the workday beyond commercial 8am. With these calculations, each patient ends up being answered within 10 to 15 minutes, which is insufficient for a clinical research quality – and often interpreted as disregard professional.

Other complaints of the medical profession

Bureaucracy is another element that generates deep dissatisfaction. private offices usually have to hire more secretaries or assistants just to handle the procedures demanded by the health insurance companies, because the wrong fill the guide, for example, can cause the query is not paid to the doctor.

paying taxes, overload, poor working conditions and interference in the professional autonomy – such as pressure to reduce the number of tests – are other arguments for those who do not meet health plans or booking only a few times for insured patients. There are also frequent reports of delay in payment of the carriers, which are sometimes made up to two months after the service.

A practical alternative billing has been applied by doctors and patients to flee the link with health plans, and is even encouraged by the Federal Council of Medicine (CFM). Rather than trigger the agreement, the professional will charge the minimum value of the particular query, which is generally very close to the reimbursement amount paid to patients by operators for consultations with non-accredited doctors. With this and the issue of the invoice, the patient can recover all or almost all of the value by the health plan, with the option to choose your family doctor and get a good service.

Deciding meet by agreement or not, it is important that the health professional sees his practice 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!

Want to know more about health insurance? Read other articles on our page!

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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