Wiki Billing Interest to Insurance Companies

[xistinalequeenofhearts@gmail.com]

Hello,
I am a spinal fusion CPC and send out a lot of high dollar claims. For certain insurance companies we see incredibly long periods before the claim finally processes and pays. My boss is asking me to find out about billing interest to these insurance companies for those situations (some of which have been 2+ years workman's comp approved cases). I have searched the internet but can't seem to locate anything about how to properly do this. I'd like to know what's possible and if it is what the figures should be to calculate it. Thanks for your help!

Kristy

 

[austin408]

I've never been in a situation where I've billed an insurance company for interest, however I have received interest from some payors (after we requested it via letter) who have taken a long time to process a claim.

I would suggest checking out the following places to see if your claims would be eligible for interest.

1. Your contract with an individual insurance company
2. State laws for worker's comp and fully-funded health insurance policies (the plan follows the state of the homeplan or the state in which the plan was issued). Try googling State Prompt Pay Laws (there should be quite a few pdfs available with each state law and the associated interest percentages)
3. For self-funded employer sponsored plans check the patient's plan document as then there might be a stipulation in the patient's plan document would allow for interest to be assessed. ERISA mandates that plans have 30 days to process a clean non-urgent claim but does not require interest to be paid if the timeframe exceeds 30 days. If they don't comply with ERISA, the member has the right to pursue legal action, which may result in interest.

Hope this helps!

 

[carrollalicia1]

I've found that if you submit a complaint to the Department of insurance located in that insurance companies state, that they either begin processing the claims quicker or they pay penalties or interest based on the state law. Make sure that you include in your complaint that you are seeking interest due to the payment delay. Most times the complaints will get their attention.

I hope this helps.