What’s the best way to handle relationships with private medical insurers?

When you’re starting out in Private Practice, as well as setting your self-funding rates, you also have to make the decision about whether you will see and treat patients who are covered by private medical insurance.

Raise the subject of medical insurers with your colleagues, and chances are, you’ll get reactions that range from ‘I can’t believe how little I get paid for a knee scope’, through to tales of woe and anger about how they were ‘removed’ from an insurer’s list.

Here’s the thing. Many patients will have private health insurance, and will want to make use of that, so even if they know you are the ‘Grande Dame’ of treating patients with bipolar disorder, they will often pass you over if your fees aren’t covered by their policy. Many insurers will take umbrage at your asking patients to ‘top up’, and so you have to decide whether you’ll play ball. Or not.

The numbers of people taking out private health insurance has been dropping, but the decline is slowing, and I have a feeling it’s going to plateau. The heady days of being able to charge whatever you like and be richly rewarded for your services are over, and many of us have not had a rise in the remuneration that we see in over a decade. Which feels a little cheeky. Insurers will argue that they want to see value for money for their patients, but on a positive note, self-funding patient numbers are on the rise.

So, what’s to be done?

When you’re starting out, I’d always recommend apply to be recognised by the various insurers, because whilst it may take a little time to fill out forms, it’s a relatively simple cookie cutter experience. Be polite. You might not feel like you owe them anything, but it pays to play nicely. Don’t be tempted to play the ‘don’t you know I trained at Cambridge and I did my fellowship at John Hopkins’ card. It makes you look a dick, insurers care about patient outcomes and supply and demand, and guess what? They already have 1,200 other doctors on their list who trained at Cambridge and then went to John Hopkins.

What can be the potential barriers? Some of the insurers will only give you the green light, if you have held a substantive NHS post. If you’ve gained your shiny CSST badge and are still bob-a-jobbing round a locum consultant circuit, you can try asking them to take this into consideration, but some may give you a flat- out ‘No’.

Some insurers will declare that they’re currently not taking on any more doctors in your discipline in your geographical area, and sometimes you’ll find that the hospital you choose to work at, may regularly be off-limits to some of their patient customers.

For example, you might find that if you work in a central London hospital (e.g. an HCA hospital), the insurers might cover the patient coming to see you for a consultation, but they won’t permit funding for any procedures or surgery to be carried out that hospital or clinic. Whilst there won’t be many patients who fall into this category, it’s worth checking out, particularly if you tend to service a large number of patients who are employed by a company, whose private health cover won’t extend to your preferred hospital.

It really pays to think about how you ‘set out your stall’ with the insurers.

They’re not paid to promote you, but you will appear on their list, so if a patient contacts them and asks which clinician they can see for their mesothelioma, if you’re a mesothelioma expert, your profile needs to state this. In other words, when filling out details about your profile, declare your niche, and make sure that it’s easy for patients to book in for an appointment, and keep those all-important clinic and contact details up to date.

You might feel that you have particular expertise in a certain area, and that you should be able to command a better fee from the insurers. Whilst you can approach them to negotiate, bear in mind the following:

  • They’re heard it all before. This goes back to the John Hopkins’ argument.
  • You might carry out a novel procedure or have a new technique that benefits the recovery over a patient. In order to win them over, you’ll need some hard data. Is there sound scientific evidence (about and beyond a few case histories) to back up that magic treatment, and can you prove that your patients have substantially better outcomes and reduced complication rates with your new and improved technique? If your data can show this, you’re in with a chance.
  • Citing ‘I treat patients with obesity and diabetes, and they’re harder to treat’ won’t get you much sympathy, but you might be able to negotiate for a higher fee if you can prove that your Oesophagectomy patients spend less time in ITU.
  • If you can demonstrate that through your novel (or collaborative) way of working, that you can reduce the number of investigations or procedures needed (e.g. less reliance than the average Joe on MRI ordering), then you’ll potentially gain favour.

Some insurers have ‘preferred’ Consultant or ‘pathway’ referral schemes (especially in the MSK world). There are pros and cons to these. You may receive a slightly reduced fee, but they will actively direct patients your way.

Because the patients are triaged, some of the finer ‘nuances’ can be missed in a referral, which may mean that you receive some patients who aren’t quite ‘your kind of people’, or who aren’t a great fit for your services. With some patience and feedback, you can overcome this problem.

And finally, don’t be ‘princessy‘ about the admin side of things. If they want you to submit billings via an online platform, don’t frustrate the process by submitting paper bills on swanky Conqueror paper, just because your secretary has ‘always done it that way’..

Need guidance on how to grow your Private Practice? Get in touch. I’m at drcath@clinic-alchemy.com

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