Wiki Help Wanted with Billing Issue


Hertford, NC
Best answers
I work for an FQHC and we have several outstanding clean claims that have not been paid. These claims go back to 2015 and some more recent; 2016-2017. Per the website all the claims were paid in January however we still have not received payment. I called yesterday and was informed that all these patient's work for the same employer who has filed bankruptcy and they will not be paying these claims. The rep was very rude to me and told me that all these claims are the patient responsibility and they can take it up with their employer. I then called all the patients and I was told that as of 1/31/17 they no longer had insurance so I called American Plan Administrators back to find out whey there were not paying for these dates since the Bankruptcy was filed in 2017 and the majority of these claims were in 2015 and 2016. I was told "whatever was paid was paid, whatever wasn't paid is not our problem". I told them that one of these dates were in October 2015 and they paid dates in November and December of 2015 so I am not understanding what the issue is and I was rudely told they are not paying the claims and the patient's are responsible. I am not sure what rights we have and I do not feel that is right that the patient be responsible when their employer did not pay premiums that they paid in!

I asked them to send us something stating they are not paying these claims and they will not send us anything either. Therefor we will have no documentation to transfer these charges to the patient!!

I am at a lost and have no clue how to proceed.
It sounds as if the employer was self insured meaning the payments of claims come from the employers checkbook and not the insurance companies checkbook. If it was for failure for employer to pay premiums it would have been a retroactive termination and the claims denied as not eligible. If its self insured, I don't think there is anything else that can be done but bill the patient.

An old article about self insured bankruptcy.
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I've encountered situations similar to this once or twice before. Likely if the insurance was active at the time of service, then payment for these should be part of the bankruptcy settlement, but you may have a very long wait before you receive payment, if at all. In these cases the practices I've worked with have not had to take any action because all of the existing liabilities that are on the books are turned over to the court for settlement. I'd recommend trying to find out who is handling the bankruptcy proceedings and whether or not you need to file as a creditor.