As medical providers, you understand better than most others just how important health insurance really is, as you work with medical insurance companies day-in and day-out. You, therefore, want and need to understand the innerworkings of said companies. So, we asked 10 medical billers a variety of questions pertaining to their own experiences with health insurance companies, in order to give you another reliable assessment to consider. And one of those questions was: Which insurance company is most likely to conduct an audit? The results are as follows:
Responses varied, but 30% of responders reported that Blue Cross Blue Shield is most likely to audit you, while 20% reported that Cigna is most likely to audit you. Several other companies tied for third, as 10% voted Medicare, 10% voted Magellan, and 10% voted UnitedHealthcare. Rounding out the statistics, 10% said that all companies are just as likely to conduct an audit, while 10% were unsure.
Brief Summaries of the Companies
Blue Cross Blue Shield (30% of votes)
Blue Cross Blue Shield got its start in 1929 and claims to have “led the healthcare industry by rising to the challenges that change brings, enabling new discoveries, and continuing to evolve.” The company prides itself on providing customers with not only high-quality, but affordable healthcare coverage, which is made possible by their experienced employees and valuable partnerships.
Cigna (20% of votes)
Cigna is a health insurance company, “dedicated to helping people improve their health, well-being, and sense of security,” according to a statement on their website. While the company got its start more than 200 years ago, they have since transformed into the company “we know today,” which prioritizes true partnership between its team and customers.
Medicare (10% of votes)
Medicare is a federal health insurance program for individuals aged 65 and older, as well as younger individuals with certain disabilities, and those with End-Stage Renal Disease. Different aspects of Medicare cover specific healthcare services, such as inpatient hospital stays, doctor’s services, medications, and even outpatient care.
Magellan Health (10% of votes)
Magellan Health also received 10% of the votes and is a company that strives every day to fulfill a few key values: integrity, accountability, collaboration, and caring. The Magellan team believes that doing so will aid them in, “leading humanity to healthy vibrant lives,” as stated online. And like Aetna, Magellan prioritizes interconnectedness, as its team works to fulfill behavioral, physical, pharmaceutical, and social needs—they view them as equally important.
UnitedHealthcare (10% of votes)
According to its main site, UnitedHealthcare serves millions of individuals, “from their earliest years through their working lives and into retirement,” which is backed by their many insurance plans catered specifically to individuals, employers, and others. Among other goals, UnitedHealthcare hopes to, “create a system that is connected, aligned, and more affordable for all involved. One that delivers high quality care, responsive to the needs of each person and the communities in which they live.
Audits need not be painful—in many cases, they are brief and routine: an insurance company simply asks for a sampling of note to ensure the services are being rendered and documented. Additionally, audits don’t guarantee you’ll owe insurance companies a single penny—in fact, you could benefit instead, as many healthcare companies find that the occasional audit helps them keep their documentation fine-tuned and compliant. Remember: decent documentation is an ethical requirement for clinical practice, not just an insurance company’s request. All that being said, an audit isn’t a reason to forego working with an insurance company—it is simply a factor to consider.