How To: Quickly Review an Insurance Agreement

Say you’ve decided to embark on a renegotiation of one or more of your insurance contracts.  You know you’re in for a lengthy, at times frustrating, process.  Finally, the payor sends you their initial proposal.  This includes a multipage agreement, several exhibits, and perhaps a variety of different fee schedules that all fit together to create your payment schedule.  You’re eager to quickly see what you have before you.  Here are some of the key elements to check for to obtain a quick lay of the land for the payor’s initial offer to you:

Fee schedule:

Fee schedule exhibits on insurance agreements can be daunting.  Check for a statement of the general fee agreement – percentage of particular year’s RBRVS and locality, percentage of proprietary payor schedule, etc.  The fee schedule will require much more analysis, but looking for this piece right away provides a good first impression of the fee offer.  While you’re looking at this, scan for any information pertaining to excluded services as well.

Timely filing:

It can be good to take a look at the offered timely filing time-frame.  If you operationally want to try for an extended time frame, it’s good to know up front what has been offered.

Termination clause and initial term of agreement:

It’s good to take a look at this information.  Many are standard, but there may be a lengthy initial term for the agreement that has been offered that is possibly unacceptable for what you’re comfortable with accepting.

This is the five minute version to quickly review an insurance agreement, just so that you can get a quick feel for what has been offered before delving in more deeply to analyze the offer.  Happy negotiating!