Re: charging Insurance companies interest on unpaid claims

[Pay_My_Claims]

Sometimes we encounter Insurances that simply take 3-4 months on average to pay our claims. My provider wants me to send them a letter "threatening" to charge interest for those claims that aren't getting paid within 3 months. Neither I nor the provider really knows what the "contract" terms with the insurance are..(the provider probably doesn't even have the paperwork anymore). Can someone direct me as to how should I go about writing such a letter. Who in the company should I mail it to and whether it is a good idea to do that. VA is one of the worst insurance because it keeps "reviewing" claims for months before finally paying or sometimes denying the claim. Can I write such a letter to VA (since it is gov. agnecy not private ins.) and does this approach work???

Thanks

Don't know about others, but we get paid interest on claims that are over the time to pay limit.

[Steve Verno]

Doctors can insist on anything they want but reality takes precedence.  Most commercial claims ar paid 45-60 days.

As a biller, I work any account that is over 60 days old.  If it hasnt been paid in 60 dys, somethng is wrong and the earliest to 60 days i can work, I have a good success in getting the claim adjudicated. 


A lon time ago, one provider I worked for ordered me to call every insurance company and ordr them to have his claims paid within 2 weks of receipt. He also wanted me to tell them not to take any discounts.  One was Medicare.  I tried to explain Medicare pays their allowed amount at 80% buy he said he doesnt care.  he wanted Medicare to pay him 100%.  he also ordered me to balance bill all Medicaid patients for the balance of his charges.  I told himhe couldny do this.  Two calls and lots of insurance company personnel laughs later, he changed his mind, especially when they wanted to speak with him.  They taught hm a lesson by (a) sending paymen to the member and (2) waiting for the last minute to pay the claim.  Medicaid sent him a letter saying if he balance billed the patient he would be in violation of State Law and he could lose his license.,

He also told me if I didnt get the insurance companies to change, I shoul dfind another job. I stood up, went and got a cardboard box.  He asked what I was doing, I said packing my things to be prepared for termination.  When he saw I was serious, because I didnt show for work the next day he saw how serious I was.  I was is last empliyee as he fired everyone else for incompetence.  He asked me to come bak, I agreed but not under his terms. we had a 4hour meeting to discuss the realities of billing.  That lasted about 2 years.  I had to leave when he refused to pay me.  He accused me of embezzlement.  MY lawyers proved otherwise.  He eventually lost his medical license and closed his practice.  In the long run, I remained faithful to current industry standard coding and blling guidelines and per the practice compliance plan.  I did what was right and didnt bend under pressure. 

[Steve Verno]

There is more to this than meets the eye. 

If the provider is contracted, you must research the contract to see if interest is permitted under the terms of the contract. You also need to read the contract to see when interest could be due. The contract may have a term that says, "Claims wil be paid within a reasonable timeframe.  Unless reasonable is clearl defined, you may be up that known creek without a paddle.  If you dont have a copy of the contract, you dont have a leg to stand on.  After al, what proo do you have that the inurance company mut pay witihn a specified timeframe and that interest is due.

For non-par carriers, you need to research your state law to see if the State Law allows interest and the maximum amount of interest.

Good luck getting the VA to pay interest.  If you wisht o attempt, you must research th eexact government laws that allow interest on VA claims. 

You will also need to know the non-par carriers where the claim and benefit payment is under the jurisdiction of ERISA. See 29 CFR 2560-503-1.  The patient's contract may state, payment of claims will be don within a reasonable timeframe. Reasonable could be 90 days, 120 days, 180 days, 365 days, or even 5 years. 

Last, to request interest, you may have to show the provider used due diligence with contacting the insurance company regarding the claim.  Also, for non-par carriers, the claim is NOT your providers claim.  The claim belongs to the patient.  Your provider aubmitted the claim as a courtesy to the member.  YOu must also know if payment was sent to the member per the terms of the contract between the member or employer.  The carrier may not be required to send the benefit payment to the provider, even if an AOB was signed.  Speaking of AOB, you must make sure you have a copy. Without it, you're also up sh*t creek as you have nothing to prove the benefit asignment was requested. Even ifrequested, the insurance company can say the patient didnt have the contractal permission to assign their benefit. 

Me? I write to the CEO or an address/person listed in the contract.

Regardinf the wordin of a letter, you may wish to consult with the practice attorney for proper language.  YOu dont want the insurance company lawyers coming after you for practicing law without a license or having your letter(s) presented as evidence in a court of law.