Profiling health funds

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Dr Mark HassedIt probably won’t surprise you to learn that health funds have a profile on the items you bill and your fees. It can be very useful if you do the same to them.

If you have a HICAPS machine you can collect data every time a patient claims — the fund name, the amount charged and the amount of the rebate paid.

Over time this lets you build a profile and see which funds pay better than others. You can then let your patients know the average rebates to expect when they claim. Of course average rebates are only a rough guide. You must tell your patients that actual rebates depend on their level of cover, how long they have been with the fund and their annual limit.

One thing that shocked me was the variability between funds. For example one large fund paid, on average, 20% less than a much smaller fund.

As they say, knowledge is power.

One thought on “Profiling health funds

    Dr Mark Hassed responded:
    August 4, 2015 at 8:30 am

    Thanks David. It is so nice to be able to show patients (from actual data) where they get the best deal.

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