Exceptional Healthcare Career Opportunity: Insurance Eligibility Verification


Once the ball drops in Times Square this coming New Years Eve,  hospitals from Bangor, Maine to San Diego, California and everywhere in between will experience an unprecedented change in the way healthcare delivery happens.  This is going to happen because January 1, 2014 is the date chosen by our politicians in D.C as the day to open the flood gates.  I say open the flood gates; because of the 30-50 million (estimated) more patients who will be automatically added to the rolls of the insured .  So once the hangovers subside and we settle into 2014, you should notice a change in healthcare.  Longer wait times and less time spent with the doctor will be the new normal.  Also, the availability of doctors will be a premium, be prepared to see more nurse practitioners, physician assistants, RN’s and LPN’s.  Not that these professionals don’t do a great job, cause they do, it is just that the level of experience is vastly different than that of an MD.

Consider a career in insurance eligibility verification.

Due to the overwhelming numbers of patients that hospitals are sure to see, they are undoubtedly going to struggle to process their claims.  Qualifying patients for medicaid, commercial insurance, medicare, charity etc. etc. will be a nightmare and will certainly drive up costs.  Insurance denials will rise, because insurance companies will be forced to look for ways to ration their dollars.  Managing claim denials will ultimately cost the hospital more.  For instance, right now lets say 25% of claims are denied and it takes one person to fix the claims and refile them.  January 1, that 25% may jump to 50-60% and may require 2-3 more people to manage those denials.  This has a ripple effect too, because these people cannot process new claims, due to the full time job of managing denials.  The manpower needed to process this increase in claims will cost the hospital directly, even if they outsource these jobs.  By the way, If you are looking to start a business, a career in insurance eligibility verification or insurance denial management will certainly be a booming necessity!  Because of this flood of newly insured, the costs of processing the increased claims will increase monumentally, so hospitals will outsource this if it is cheaper than having full time employees.  These costs have to be passed on, which means your healthcare costs will increase, and your care will likely decrease.

Out of Pocket Expenses Going up

If you are blessed to have commercial insurance like Blue Cross Blue Shield, expect them to require higher deductibles going forward.  If you have a $1000 deductible look for that to increase to $2500 or even $5000.  Now, that means that you will self-insure all your medical needs until you have reached an out of pocket amount of $2500.  Not only are your premiums likely increasing, but you are also going to have more out of pocket expenses because it may take you months to reach your deductible.  Also, because of Obamacare, Insurance companies can no longer deny coverage, so more sick people will get insurance, yea!  But, because of this, and  the need for insurance companies to spread the risk, the healthy people will pay the price to afford them their coverage.  Kinda like redistribution of wealth?

Get ready for the changes now

Now, I certainly do not want to be the bearer of bad news, I am simply trying to educate.  So, in an effort to do so, here are a few recommendations to get yourself ready for the changes.  If you can afford it, find a policy with a reputable insurer, one that has an AM Best rating of A or A+.  Before accepting the policy ask them to advise you on what to expect in 2014 and beyond.  They all are educated to respond to these questions.  Familiarize yourself with your states insurance exchange legislation.  There are states which have not set up an insurance exchange yet, and may not for that matter.  The exchanges will offer 4 different tiers of coverage: bronze, silver, gold and platinum. The difference between tiers will be the percentage covered before the patient must pay co-pays, co-insurance or deductibles.  Also, if your insurance is provided by your employer, talk to them before the new year about their plans for making changes to the group policy.  Know what to expect before the changes happen!  Lastly, I do think there will be legislation that will make changes to Obamacare in the future, what we have today will likely not be what we have 10 years from now.