Midwest Doctors Call for Investigation into Anthem
- By admin aapc
- In Industry News
- June 12, 2009
- Comments Off on Midwest Doctors Call for Investigation into Anthem
Indiana and Ohio physicians want to know why they are being paid late and experiencing payment errors and excessive waiting times for customer service. They say Wellpoint subsidiary Anthem is to blame.
Doctors in both states have reported waiting as long as several months for claims payments from Anthem, according to American Medical News.
Ohio’s prompt pay law requires insurers to pay clean claims within 30 days; Indiana’s law requires electronic claims to be paid within 15 days and paper claims within 45 days.
Anthem reportedly said the problems were due to implementing a new system to process claims under the BlueCard network, but that most of the bugs have been worked out.
Indiana and Ohio State Medical Associations disagree and have asked their state regulators to investigate.
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I temporarily worked for Anthem in Indiana and I believe the delays are due to outsourcing. It seems that people fail to understand that the healthcare system in America is complex and you cannot train someone in 6 – 8 weeks to learn our system. Especially to countries that have no healthcare plans at all. So they may want to think about bringing the jobs back to America for Americans.
I believe that some claims are being processed promptly, whereas other claims for larger dollar amounts are being placed on a back burner. I do followup for physicians and long term care facilities. In addition, when a claim needs an adjustment, it seems to get “lost” in cyberspace.
It has gotton so bad here that we are now sending claims via United Parcel Service to track them. (even though the bulk of our claims go electronically, many times they aren’t found in their system, when we call for claim status. We even have had to provide proof that they were filed through an acceptance report to Blue Cross…with regards to correspondence, which is required from time to time for claim adjudication, we have been told on more than several occassions to allow 45-60 days for material to even be SCANNED….this is outrageous.. it’s time for providers to stand up to this…we have been told many times by the Provider Reps” no one else has been having this problem….” BALONEY….they have gotton too big too fast… and now… are they too big to fail???
This is not new….this has been happening with Anthem for years. Claim delays, large dollar amounts systematically denied. Random payments for services based on no true reasonable and customary data and refusal to provide that data. Claims in appeal for years. Why the outrage now, when we’ve had the problems for years? It will get worse with the faulty Blue Card system. However, if you are having any problems that were identified in the Love vs. BCBS suit, I implore you to file a dispute and contact Deborah Winegard, the claims dispute administrator who truly helps with these problems. It’s a shame these blues and their monopoly are still getting away with treating providers like they do!
How about those bogus questionnaires that the patients need to fill out and send back BEFORE the doctor gets payment. Most patients throw them away until they realize from our follow up phone call that payment is being held up. Can we say “interest earning”?
We have seen an increased amount in the Richmond, Virginia area of claims being denied for inappropriate reasons. Very frustrating for the coders to give the billers the documentation to justify the coding and yet they still deny. We need to stay on top of this and not allow this company to dictate new rules as they see fit for their own gain!
This problem seems to be national as we also have the same problem here in Nevada. The majority of my claims problems lie with Anthem BCBS and Blue Card. Claims denied incorrectly and claims which require “Additional information”, half the time we never receive the request for additional information and then they deny the claim because the information was not received. I also found out recently that when a “Claim Action Request Form” is submitted, I then have to call Anthem so they will pull it and send it to be adjudicated. It’s very frustrating as it usually requires several phone calls to get claims processed correctly. Anthem BCBS has over extended themselves and it’s the patients and physicians who suffer.