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colleensso

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Has anybody been able to collect money on time from any of the Local medical insurance companies? They seem to think they don't have to follow any guidelines for payment. I know Magnacare prices them out and sends them to the Local, but then they sit on the payment for as long as they want. What should I do?

Please help a frustrated Biller
 
colleensso said:
Has anybody been able to collect money on time from any of the Local medical insurance companies? They seem to think they don't have to follow any guidelines for payment. I know Magnacare prices them out and sends them to the Local, but then they sit on the payment for as long as they want. What should I do?

Please help a frustrated Biller
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I believe insurers are now mandated to pay a clean claim within 30 days or they owe you interest! I am in RI and our Blue Cross does pay within 2 weeks, but some of our carreir are out 4 and 6 weeks and we do see the interest payment. It's pennies on the dollar, and it may not help you get paid on time but I thought you should know there is at least one mandate that is suppose to help keep them paying on time!
 
thank you for your response. I have some Locals that take up to 6-8 months and say they don't need to follow any regulations. I have found Title 29 of the United States Code of Federal Regulations. This portion of Pension and Welfare benefits law prohibits self-funded group employer-sponsored health plans from unnecessarily delaying claims processing. Section 2560.503-1(f)(2)(iii), "Other Claims," I was wondering if that would pertain to all locals? If not any other ideas?

colleen
 
Locals

It is my understanding that the Locals are not insurance companies so they do not have to abide by clean claim timing payment rules!! We have the same trouble with Magnacare and other self-insured plans. We often contact a plan administrator and lodge a complaint, but it seldom helps...
They have us between a rock and a hard place..
 
If they are self-insured payers, the insurance commissioner will not have any jurisdiction over them. ERISA would apply and there's no easy way to pursue these types of payers. If self-insured, complain to the employer instead and get the patient involved. We've found this is a much more effective way on these types of plans.
 
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