Insurers Sometimes Ignore Claims
May 13, 2001
Health insurers and HMOs are notorious for their stall tactics when it comes to paying for doctor visits and medical procedures. Just ask Washington, D.C. resident John Smith who realized that several of his claims had either been delayed or completely ignored by his insurer. When performing an end of the year review, Smith noticed that two of his claims filed over 6 months prior had not yet been paid. The insurance company requested additional information on one claim and simply ignored the other. "It makes you wonder if they're hoping I'll just forget it," he said -- which, he admitted he did.
While doctors have been complaining for years about delayed insurance company payments, patients are increasingly feeling the pinch. Many individual patients report that they often must submit claims more than once in order to get a satisfactory response from insurers. Insurance companies and HMOs deny that they are participating in any sort of systematic delay tactics. "We have looked at the issue, and our data indicate that most claims are paid within 14 days of receipt, and considerably faster if the claim has been sent electronically," said Richard Coorsh, spokesman for the Health Insurance Association of America, an industry group.
The American Medical Association (AMA) reports that nearly 40 states have laws that require insurance companies and HMOs to rapidly reimburse doctors. No such legislation exists to promote rapid payments to patients however. "The insurance companies would rather have the money in their accounts than our accounts," said David Lindquist, president of the Oregon Medical Association.
While late payments are an annoyance, many doctors and individual patients are now complaining that insurers and HMOs simply ignore claim requests altogether, perhaps hoping that such doctors and individuals forget they made the claims in the first place. Insurance companies realize that doctor office staffs are already overloaded with an abundance of paperwork and that many claims are likely to simply be forgotten. "I suspect for those who are in small practices, that they just run out of patience and in some cases will give up. It's their working staff that has to follow through and when there are more pressing issues. . . . those things that are the most difficult to resolve get pushed to the back burner," said Mr. Lindquist.
As far as individual patients, many observers feel that they are even more likely to succumb to insurers' delay tactics. "Quite a few people are rather intimidated by big organizations and figure they must know and 'Who am I to question it?' . . . For some [others] it may not be worth the hassle," Hunter said. "There must be a certain percentage" of people who don't pursue their claims, "otherwise it doesn't make sense" for insurers not to pay them promptly, said Robert Hunter of the Consumer Federation of America. Consumer groups like Hunter's recommend that individuals keep well organized medical records should the need arise to challenge their insurance company or HMO.
-- Article Courtesy of InjuryBoard.com
More ...
- UnumProvident Corporation
- California Fines Kaiser HMO
- UnumProvident Corporation Loses $84.5 Million Verdict
.