The "Naughty List" You Want Your Company On

• Report this Comment On May 29, 2009, at 5:26 PM, hmoguy wrote:

  Brian,

  I think some of your comments are way off base. Interest rates are so low right now that trying to make money by slowly processing claims doesn't make a lot of sense. Also, almost all states have laws which require insurance companies to pay or deny claims in a reasonable amount of time. Many HMO's have paid large fines that easily offset any interest that they made.

  The best thing for an HMO is to pay claims quickly and accurately. If a claim isn't paid quickly, providers resubmit and the HMO's claims dept gets multiple copies of the same claim which can lead to duplicate payments or additional processing costs to deny the second claim. Additionally, the financial statements and underwriting calculations can be off because of slow payments causing an HMO to underprice future premiums.

  I think an interesting analysis would be to take the data in your article and compare it to the same number calculated from the HMO's financial statements. Are the HMO's reporting the same way an independent body says that they are paying?

  My guess is that some companies may be underaccrued.

• Report this Comment On June 01, 2009, at 1:48 PM, asmgator87 wrote:

  Another consideration is cost to the insurer to withhold payment beyond 30 days. Many billing companies will call or refile claims that are not paid within 30 days. Since the patient's premium is payment into the fund that pays the bills, any additional cost such as a claim inquiry will reduce their profit - likely by more than they can earn in a month worth of interest.

  If you look closer at athenahealth, and I did, they include a very important component for a billing agency - claim rules that are tailored to each insurer. This means they can literally submit claims that should not be denied. It's a win-win with the insurer when you can do that. The billing agency has lower cost because they do not have to follow up on as many claims. But the insurer has to cooperate or they will drive up their cost, the billing agencies' costs and ultimately the cost to the general public.

  One more point. If I see that my insurer is on a list like this, you better believe I will call them. My premiums are never late. Why should they make my doctor want to reduce the number of patients he sees covered by their plans? See how much they want to answer that question and get on their customers' lists! I would not be surprised if the insurer at the bottom of this list gets a flurry of calls just by being #7 or 8!

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