Sunday Morning Bathroom Read (“Nope” Edition Part I/And yes, it is a two part series):
Random thoughts as I read this article:
“The most powerful word in health care is “Nope” second, of course, to “Amounts Generally Billed”…”
“I am sorry ma’am, but we are not paying. Nope.”
“It’s the latest poll of physicians ( all 12 of them who bothered to respond) alleging insurers aren’t complying with arbitration decisions.”
“The claim review was over 25 claims… “
“According to AFHC’s survey, after the dispute resolution process, 33% of all claims paid were made in an incorrect amount (“Overpaid”); 52% of arbitration-determined payment amounts weren’t paid at all (“Nope”); and 49% of claims that were paid were ultimately paid late (“We sent little Johnny to the post office 7 months ago. You did not get it yet?”)
Article Summary Below:
“That process started last year but quickly ran into a number of roadblocks, including a backlog in disputes that can push decisions (and subsequent reimbursement for providers) back months as regulators received a tsunami of requests for intervention in billing disputes. In addition, provider groups have filed a string of litigation challenging the system that forced regulators to revamp how providers and insurers hash out disputes earlier this year.
According to AFHC’s survey, after the dispute resolution process, 33% of all claims paid were made in an incorrect amount; 52% of arbitration-determined payment amounts weren’t paid at all; and 49% of claims that were paid were ultimately paid late.
It’s the latest poll of physicians alleging insurers aren’t complying with arbitration decisions. Another survey of emergency room doctors conducted last year also found payers were ignoring or delaying dispute resolution claims.”
Health insurers ignore surprise billing decisions, providers allege | Healthcare Dive
EDITOR’S NOTE: Adam Learns He Has A Premium Paying Policy
