Curious question

[houseCallexam]

I've recently joined this forum but all the posts I've seen were from 2007 lol! I'm interested in becoming a direct independent examiner but I'm curious how I would bill the insurance companies. I'm also having trouble finding any info regarding exactly how I should be billing, but more importantly, how much I should be billing. I'm obviously in the infant stages of this process and trying to do my research. Not finding anything at all has become frustrating so I figured I could ask in this forum and hope someone has some inspirational advice for me lol.

I appreciate any info you all have and I'd love some direction on what I need to do first. Working for apps for way too long and the fight to get what's owed to me has become distressing, especially when they clearly could care less that I'm as skilled as I am and haven't had any mistakes or deductions. It's so obvious that they don't care at all about their customers, despite them acting like they do. If they did, they would pay more to keep their experienced examiners rather than paying them the exact amount of money that they pay brand new phlebotomist. They make no sense, yet they have a monopoly on this whole industry. I'd really love to shake that up lo!!
Thanks for your help!

 

[adjusterjack]

Independent examiner of what?

 

[scagnt83]

Independent examiner of what?

They are talking about Paramed Exams for Life Insurance.

 

[scagnt83]

I've recently joined this forum but all the posts I've seen were from 2007 lol! I'm interested in becoming a direct independent examiner but I'm curious how I would bill the insurance companies. I'm also having trouble finding any info regarding exactly how I should be billing, but more importantly, how much I should be billing. I'm obviously in the infant stages of this process and trying to do my research. Not finding anything at all has become frustrating so I figured I could ask in this forum and hope someone has some inspirational advice for me lol.

I appreciate any info you all have and I'd love some direction on what I need to do first. Working for apps for way too long and the fight to get what's owed to me has become distressing, especially when they clearly could care less that I'm as skilled as I am and haven't had any mistakes or deductions. It's so obvious that they don't care at all about their customers, despite them acting like they do. If they did, they would pay more to keep their experienced examiners rather than paying them the exact amount of money that they pay brand new phlebotomist. They make no sense, yet they have a monopoly on this whole industry. I'd really love to shake that up lo!!
Thanks for your help!

I think the issue you will run into are reimbursements from the Carriers.

ExamOne, APPS, IMS, Parameds.com; are the usual suspects who are already pre-approved by Carriers for reimbursement.

That means the Agent/Agency does not have to pay a dime up front for the service. The Exam company bills the carrier directly, since they are a pre-approved vendor.

As an independent examiner, you have 2 options:
1. Bill the Agent, and let the Agent get reimbursed by Carrier. (I would suggest money upfront)

2. Take a chance and ask the carrier directly for reimbursement.

Very few agents will be willing to pay upfront and go through the hassle of being reimbursed by the Carrier. Only big producers would do that.... and you would need to "sell" them on the value provided. (very little to be honest)

You being reimbursed by the Carrier is not guaranteed if you are not a pre-approved vendor. Each Carrier has their own requirements and standards for Vendor Reimbursement.

So option 1 is an extremely hard service to sell agents on. And option 2 is a risk that you dont get paid for your work.

---

There is also the lab side of the equation....

Not all Labs are pre-approved by Carriers.

If not pre-approved, you would have to pay the Lab and hope to be reimbursed by the Carrier.

---

This is why there are very few "independent" paramed examiners out there. You need an established structure and agreements, for it to be attractive to most Agents.

The amount of agents willing to pay directly for an Exam is tiny... minuscule...

It is much more common to order and pay for the APS themselves rather than the Paramed.

---

I think right now could be great time to start a Paramed company. Even a combo paramed/lab company. (like examone)

But that takes agreements with Carriers, agreements with Labs, and a network of Examiners.

However, it could be a dying industry. Many carriers are trying to move away from Paramed Exams. Using existing Labs from the APS, or even completely electronic UW.

Labs are being ordered less and less in our industry. And that trend will only increase.

 

[Allen Trent]

Quality of examiners is at an all time low in the industry, but understandably so. Near monolpoly from the national vendors, the pay to the examiner is so low along with travel distance to client. Examiners can make more money getting other jobs. Examiners & exam companies end up being a customer service pain point for the insurance carrier as they have no control. So, the carriers are investing more money to pay for algorithms & public data to try to avoid exams.

I dont think you are going to find an easy route to make this a viable business unless you have a direct connection to large carrier in a large market that would be willing to do a trial with you

 

[scagnt83]

I dont think you are going to find an easy route to make this a viable business unless you have a direct connection to large carrier in a large market that would be willing to do a trial with you

This

 

[scagnt83]

Quality of examiners is at an all time low in the industry, but understandably so. Near monolpoly from the national vendors, the pay to the examiner is so low along with travel distance to client. Examiners can make more money getting other jobs. Examiners & exam companies end up being a customer service pain point for the insurance carrier as they have no control. So, the carriers are investing more money to pay for algorithms & public data to try to avoid exams.

They can learn a lot from ordering medical records. Ive never really understood the need for an exam tbh. Not to the extent they do it at least.

I understand if its a large policy, or if the person has no medical records to look at.

But they will order exams on insureds who just had bloodwork done at the doctor. For a $500k term policy. Then they spend hundreds more ordering the APS. How is a random paramed examiner's results more accurate than a doctors office? And the only thing the Doctor might miss is a full lipid panel. So basically they are spending hundreds per insured to screen for alcohol abuse??

And these days, pretty much anyone with a serious health condition and is treated by a doctor, has a RX report showing the illness.

Finally, some carriers are starting to be selective in ordering Parameds. But it still happens too often imo.

 

[Life Hawk]

I wonder how doctor visits play into this?
In the past it seems few people visited the doctor on a regular basis, so less data to pull from. Now even young ones are regular to the doctor, more data, better historical data for an informed decision.

Just thanking...

 

[Allen Trent]

They can learn a lot from ordering medical records. Ive never really understood the need for an exam tbh. Not to the extent they do it at least.

I understand if its a large policy, or if the person has no medical records to look at.

But they will order exams on insureds who just had bloodwork done at the doctor. For a $500k term policy. Then they spend hundreds more ordering the APS. How is a random paramed examiner's results more accurate than a doctors office? And the only thing the Doctor might miss is a full lipid panel. So basically they are spending hundreds per insured to screen for alcohol abuse??

And these days, pretty much anyone with a serious health condition and is treated by a doctor, has a RX report showing the illness.

Finally, some carriers are starting to be selective in ordering Parameds. But it still happens too often imo.

Doctors labs don't test for cocaine, aids, tobacco, weed, & whatever else the carriers think impacts risk. I am told actuaries have seen mortality slippage since going away from exams as more people are approved at risks class they wouldn't have been if exams had been conducted.

Exams & medical records are worse today than 2 decades ago it seems

 

[Allen Trent]

I wonder how doctor visits play into this?
In the past it seems few people visited the doctor on a regular basis, so less data to pull from. Now even young ones are regular to the doctor, more data, better historical data for an informed decision.

Just thanking...

Christmas Dinner of 22 people of all ages. 6 of them were age 18 -26. 3 of those 6 have had or will have colonoscopy between November & early January. How many of us had a colonoscopy before age 50 ish?

Medical files & script check data base are flooded in recent years it seems.