Author Topic: Networks wanting to take a discount  (Read 1893 times)

ste

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Networks wanting to take a discount
« on: October 16, 2011, 01:53:03 PM »
A patient has out-ofnetwork insurance benefits and is treated by an out-of-network provider. Before the insurance will pay on each claim 2 different networks must be contacted and each given a certain amount of time to get back to the insurance with notification of weather the provider is in-network or out-of-network. This process takes a fair amount of time and slows reimbursements to 2 to 3 months. Is there something I should be doing or can be doing to speed this process up a bit?

Michele

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Re: Networks wanting to take a discount
« Reply #1 on: October 17, 2011, 11:45:56 AM »
Wow, I haven't come across that.  It seems ridiculous!  Is the provider accepting payment from the insurance carrier or are they getting payment from the patient?  If they've agreed to accept payment (even as out of network, since the patient has out of network benefits) I don't see what can be done.  It does seem outrageous though!
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ste

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Re: Networks wanting to take a discount
« Reply #2 on: October 18, 2011, 04:43:23 PM »
To make sure I understand your question lets clarify insurance. There is the mega-company insurance (insurance A) that I submitted the claim to. Then there are the two smaller insurance companies, or networks, we'll call insurance B and insurance C.
The provider has chosen to accept payment from insurance A and has not collected any payment from the patient. The provider has chosen not to accept payment from insurance B and insurance C. These offers are the ones that come by fax trying to entice the provider by offering a speedy reimbursement, but at a lower rate.
I come across these offers being sent to providers all the time. How come you never see them?

Michele

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Re: Networks wanting to take a discount
« Reply #3 on: October 21, 2011, 07:18:33 AM »
We do receive offers from other companies (but not insurance companies) that try to get our providers to accept a lower rate for a "speedy reimbursement".  That didn't seem to be what you were describing in the original post.  I've only ever seen them send it to one third party company that then faxes us the offer.  I've never seen two companies involved.  But if they are offering a speedy reimbursement the 2 1/2 to 3 months seems to negate the offer immediately doesn't it?  I haven't had that problem.  We have a STRICT 'no negotiation' policy when it comes to these offers.  I personally (PET PEEVE) think it is OUTRAGEOUS that these companies send out our claim info (seems like it should be a HIPAA violation) to a third party company so that they can try to get the provider to take less so that they can get paid for doing it???  Talk about a middle man.  I have also had them get more aggressive and call me.  They are rude like a collection agent (sorry!  no offense to anyone in collections - but I'm not late on any bill so they have no right talking to me that way).  Anyway I told them unequivocally "NO".  In fact, sometimes the offer came AFTER payment was made by the original carrier ?!?!?  THey didn't believe me.  I do not negotiate and I do not respond to these rediculous requests.  JMO    ;D
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PMRNC

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Re: Networks wanting to take a discount
« Reply #4 on: October 25, 2011, 07:22:46 AM »
Quote
We have a STRICT 'no negotiation' policy when it comes to these offers.  I personally (PET PEEVE) think it is OUTRAGEOUS that these companies send out our claim info (seems like it should be a HIPAA violation) to a third party company so that they can try to get the provider to take less so that they can get paid for doing it???

AGREE!!!  But you can't even imagine how many providers I have talked to that blindly enter into these and once they do.. forget it.  :o ::)
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Michele

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Re: Networks wanting to take a discount
« Reply #5 on: October 25, 2011, 11:29:59 AM »
I know!  They get those letters and don't think it thru.  They think they must sign them to get paid!  That's why I'm a firm believer in outsourcing.  If not, then make sure your in house staff has the knowledge needed.
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