If your health insurance company is not paying claims promptly, the state may soon come calling.
Georgia Insurance Commissioner John W. Oxendine this week fined UnitedHealthcare and three sister companies—UnitedHealthcare of Georgia, Inc., American Medical Security Life Insurance Company, and Golden Rule Insurance Company—a combined $750,000 for allegedly not paying thousands of health claims promptly. Oxendine made it clear that he's not done with his investigation and may soon levy more fines against other insurers in the near future.
Oxendine made his decision after UnitedHealth submitted claims data through March 31, 2009, which reportedly showed that the company and its subsidiaries did not pay claims promptly.
UnitedHealth sent a statement to me on Monday that said the fine involved a "small percentage of claims not processed within 15 days." The health insurance giant said the company processes 97% of its claims within 15 days and 99% of claims within 30 days in Georgia.
I find it humorous that states are going after health insurers for the promptness of claims payments when these same states are some of the worst payers in healthcare. State Medicaid programs pay much lower than private health plans and are far from prompt.
For instance, athenahealth's fourth annual PayerView Rankings that were released in May found that state Medicaid programs lagged far behind private insurers and Medicare. In fact, Medicaid had double the number of days in accounts receivable than other insurers and denied more than one in every five claims.
Athenahealth, an Internet-based provider of business services to physician practices, evaluated 172 national, regional, and government payers in 40 states, and provided three trouble spots that often lead to delayed physician payments:
- Health insurers' varied policies and procedures for claims submissions and payment that can cause confusion in physician offices.
- Real-time claim adjudication that don't help practices integrate the technology into their workflow, but is really a euphemism for additional work for practices, such as needing to rekey information onto the payer's Web site.
- Insufficient resources for providers, including inadequate call center staff, which makes it difficult for offices to research and/or follow claims, leading to misinformation and additional phone calls to resolve the issues; outdated and difficult to find provider manuals and other documentation; and incomplete information that doesn't provide enough insight to help offices learn where they may have made mistakes in the process.
Health insurance companies should take athenahealth's comments to heart. Payers need to prepare for more states to come knocking on their doors if they are not paying claims promptly. That means streamlining policies and procedures, creating real-time claim adjudication that removes barriers for physicians' offices, and providing the proper outreach and communication so that physician offices don't need to spend hours on the phone each week with insurers' call centers.
Health insurers are the bad guys in healthcare, whether you like it or not. This means they are easy prey for state officials. Though Medicaid reimbursements are often slow and lacking, health insurers can't use that as an excuse when the state fines or questions their promptness.
They need to instead understand that removing barriers for physicians and working with doctors are more than a way to make physicians happy. It's also a way to avoid becoming the next headline when a state decides to make you an example.