Author Topic: Ins. Co. Stall Tactics  (Read 3718 times)

williamportor

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Ins. Co. Stall Tactics
« on: October 02, 2014, 05:53:48 PM »
Hello-

Perhaps you folks can give me some advise on something:

An insurance Co. (United Health Care) has told my Chiropractor client that he has to wait 30 days for insurance checks lost in the mail to be reissued, in addition, any change of address requests will take no less than 3-4 months to process, since my client changed mailing address's recently, it will take no less than
4-5 months to start receiving payments for work he did in July of this year (assuming the insurance Co. is even telling the truth.) Is there a legal remedy we can look in to on this? It's clear the insurance Co. is simply stalling. We've written a complaint to the state insurance commission (In California), but don't know what else we can do. My Chiropractor client is looking to me for guidance, but I've run out of ideas. Any suggestions would be helpful.

tallmanusa

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Re: Ins. Co. Stall Tactics
« Reply #1 on: October 02, 2014, 07:36:22 PM »
Most insurers are not paying Chiropractors, and delaying payments if they pay at all.
Most of the established billing companies do not take Chiropractors as clients. If you take them, charge a flat fee.

kristin

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Re: Ins. Co. Stall Tactics
« Reply #2 on: October 02, 2014, 08:40:55 PM »
1. 30 days to reissue a check is pretty standard, for insurance companies. It should be 30 days from the date on the check.

2. When our office moved seven years ago, I started the process of contacting insurance companies to change our address six months before the effective date of the new address. It did indeed take some insurances 3 or more months to change our address, and some even longer than that.

While I am no fan of UHC, I don't know that what they are doing are actual stall tactics. One thing you could do is switch the provider to EFT for UHC, so the checks go directly into his bank account. That should take less than a month to take effect.

DMK

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Re: Ins. Co. Stall Tactics
« Reply #3 on: October 03, 2014, 10:25:27 AM »
Most insurers are not paying Chiropractors, and delaying payments if they pay at all.
Most of the established billing companies do not take Chiropractors as clients. If you take them, charge a flat fee.

Wow.  You're very wrong.  We've been in practice for 14 years and rarely have a problem getting paid.  We code and bill correctly, and verify benefits prior to billing. 

There are companies that are notoriously slow payers.  But, state laws usually give them a time limit for payment of clean claims, when filed properly. 

The quote that UHC gave you is pretty standard for ALL insurance companies regarding lost checks.  They are generally faster than that, but they have to cover their butt.  Address changes can be really fast (Anthem Blue Cross was almost immediate, as was Blue Shield)  if you call provider services directly and get a live person with the authority to do the update.  Medicare was miserably slow, but we had several changes all go in at the same time, so it probably wasn't too out of line, and it was MY responsibility to ensure that all the paperwork was filled out properly and all attachments correctly attached.

It is unfortunate that with all the electronic capabilities that the "human element" still slows it down because someone actually has to do the input and verify the information.  Mistakes get made, in boxes get full, and unfortunately not everyone cares about their work and doing their work efficiently so that everyone gets good service.

I know I'm becoming a dinosaur because I still believe that what I do matters, and it's important that I do my job efficiently and quickly.  People are counting on me to do my job.

Don't be discouraged!  It'll all work out!

PMRNC

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Re: Ins. Co. Stall Tactics
« Reply #4 on: October 03, 2014, 02:36:12 PM »
I'm with DMK on this one and also because I've worked for insurance carriers.. If any other company had a check to re-issue it would be same practice. Insurance companies (despite what people think) do NOT have "stall" tactics", they are rated and they do everything they can to make sure their ratings are not negative.

On side note.. of all providers I've worked with and processed claims for.. chiropractors rate 2nd on the list (behind DME) of fraud/abuse.   Just saying. Let's be fair here.
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tallmanusa

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Re: Ins. Co. Stall Tactics
« Reply #5 on: October 03, 2014, 03:15:11 PM »
We bill for over one hundred Chiropractors, so we know a thing or two about Chiropractic billing.
We sign up one new every day.
We are not business or marketing geniuses, far from that.
There is NO major billing company in the United States that I know of, that would take them.
The reason is simple, insurance companies would simply not pay them.
How do we make any money?
We charge them a flat monthly fee as a minimum. They do pay; some of them don't collect enough from the insurers even to cover our monthly fee. If they don't pay we terminate their contract real quick.
For some of them it does not make sense to hire a biller, but they do hire us.

shanbull

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Re: Ins. Co. Stall Tactics
« Reply #6 on: October 03, 2014, 04:25:18 PM »
I work for 3 chiropractors, they all make money. They bring in the 2nd highest amount of revenue on their claims behind physical therapy. It's pretty straightforward, either it's covered or not. If it's not covered, we don't bill for it in the first place, because we verify benefits before seeing patients. Also at least half of our chiropractic patients are injury cases anyways, and the reimbursement for that is very high. It pays much better than health insurance. So if a chiropractor isn't making money, the problem is not necessarily the specialty. It's that the chiropractor isn't seeing the right patients and isn't paying attention to policies and coding/documentation requirements. There's no mystery involved in it, at least here. Maybe it's different in other states.

3 months for change of address sounds a bit long but still within the "standard" time frame. Call every week and bug them and they'll process it more quickly so they don't have to keep hearing from you  ;)

PMRNC

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Re: Ins. Co. Stall Tactics
« Reply #7 on: October 03, 2014, 06:24:32 PM »
Quote
There is NO major billing company in the United States that I know of, that would take them.

BINGO.. nuff said there.

Quote
The reason is simple, insurance companies would simply not pay them.

Incorrect. You bill properly, you get paid according to plan benefits.

Quote
We charge them a flat monthly fee as a minimum. They do pay; some of them don't collect enough from the insurers even to cover our monthly fee. If they don't pay we terminate their contract real quick.
For some of them it does not make sense to hire a biller, but they do hire us.

That should be the way it is for any provider.. why target chiropractors? In one instance you say it's because insurance companies don't pay.. so they think they hire an OFFSHORE company they will get paid?

sorry, probably turning this into a discussion that doesn't belong.

Again, as someone who has processed claims for 3 of the top 5 carriers in the US.. Chiropractors rank 2nd in fraud/abuse.. (second to DME) #3 is laboratories.
Linda Walker
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www.billerswebsite.com

Michele

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Re: Ins. Co. Stall Tactics
« Reply #8 on: October 05, 2014, 01:42:12 PM »
We do bill for chiropractors.  They all do get paid by insurance carriers.  The problem that we see is that with deductibles and copays going up the patient out of pocket is higher and the insurance reimbursement is lower.  But they are still getting paid.  That is why percentage billing is not so good.  But flat fee billing works for them and depending on the provider, they can bring in a good income. 
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Michele

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Re: Ins. Co. Stall Tactics
« Reply #9 on: October 05, 2014, 01:46:35 PM »

Again, as someone who has processed claims for 3 of the top 5 carriers in the US.. Chiropractors rank 2nd in fraud/abuse.. (second to DME) #3 is laboratories.

Just curious, podiatrists first?
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williamportor

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Re: Ins. Co. Stall Tactics
« Reply #10 on: October 05, 2014, 02:13:02 PM »
Thank You everyone for the input. I found a way around the problem, it's getting my client set up for direct deposit, it's much faster to set up, and get's my client paid faster as well. Sorry for the false alarm. It would have been helpful if the Ins. Co would have volunteered this info. but that's not their policy 

PMRNC

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Re: Ins. Co. Stall Tactics
« Reply #11 on: October 05, 2014, 07:43:25 PM »
Quote
Just curious, podiatrists first?

Nope, DME #1, Chiropractors are a fast 2nd and #3 is laboratories..    Of course.. this can be different when talking "in patient".. NURSING homes ranked #1 in fraud.. still do.
Linda Walker
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