Results 1 to 6 of 6

Thread: I have a Really Important Question

  1. #1

    Default I have a Really Important Question

    Promo: Code Books
    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

  2. #2

    Talking

    Quote Originally Posted by colleensso View Post
    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
    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!

  3. #3

    Default

    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

  4. #4

    Default 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..

  5. #5
    Join Date
    Apr 2007
    Location
    Charleston, South Carolina
    Posts
    640

    Default

    You may want to file a claim with the local insurance commissioner. Multiple repeated complaints will get noticed.
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

  6. #6

    Default

    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.
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    www.ambanet.net/AMBA.htm
    AMBACode Coding Software
    http://www.ambacode.net
    2015 AMBA National Medical Billing Conference
    http://www.ambanet.net/2015.htm

Similar Threads

  1. Networking - so important
    By Alicia Scott in forum Employment General Discussion
    Replies: 10
    Last Post: 10-07-2011, 11:35 AM
  2. Important question
    By daniel in forum Medical Coding General Discussion
    Replies: 6
    Last Post: 09-18-2009, 07:54 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.