Administrative Overhead und Verzögerungskosten durch manuelle Versicherungs-Koordination

Definition

Admin overhead arises from: (1) Eligibility verification: manual checking of patient age, marital status, prior-cycle history, and insurance plan terms—typically 20–30 minutes per couple. (2) Treatment-plan preparation: center staff draft, submit, and track approval status for each treatment. Multiple resubmissions if incomplete or outdated information. (3) Denial management: ~10–20% of claims are denied or rejected (missing docs, causation errors, coverage lapses). Each denial requires appeal, supplementary documentation, and re-submission—5–15 hours per appeal. (4) Mixed insurance coordination: couples with GKV + private insurance require separate claims filed to each insurer, different cost-sharing calculations, and reconciliation of reimbursements. (5) Compliance documentation: centers must retain treatment plans, insurance approvals, cost-sharing agreements, and refund records for 6–10 years (statutory retention). Storage, retrieval, and audit-response labor is substantial.

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Family Planning Centers.

Affected Stakeholders

Billing/administrative staff, Patient intake coordinators, Insurance liaisons, Compliance officer, Finance/AR staff

Related Business Risks