This isn’t quite severe enough to make it into the Pit, but does contain a level of idiocy beyond which I usually see. I wanted to share the incredulity.
I work for an ENT/surgical practice as a billing specialist. We regularly receive correspondance from insurance companies requesting additional information or other things before they will pay a claim. (Usually this is referred to as “delay in payment.”) However, today I received a letter from an insurance company (which I won’t name) that exceeds the usual levels of uselessness. I can’t imagine they actually spent the $0.37 for First Class postage to send it. (Letter has been altered to stay within HIPAA compliance.)
*"This letter is to notify you that we received a claim form for treatment to (Jane Doe) received beginning April 4, 2005. To process this claim, we need additional information, so we will be requesting medical records from you.
"We will request the medical records from you in another letter; you don’t need to send any medical records now.
“If you have questions, please call our Customer Service Center at our toll-free number,”* yadda yadda yadda.
Is it really just me, or was this a totally useless & idiotic letter? Why didn’t they ask for the records now? :rolleyes:
Anyway, this definately fits in as pointless, but I just HAD to share.
Not really. If the game is to delay payment, by doing this they can put you off even longer by forgetting to send the second letter in a timely manner. This is where the SDMB needs a “Duh” smiley…
I should’ve pointed out that I was aware that it was an additional stall tactic…in fact, I feel pretty comfortable in the reasoning that they only sent this out in order to meet state laws that require us to be notified of a problem within a certain amount of time on a “clean claim” & now they can take their time.
I’ve just never seen one that’s so BLATANTLY a stalling technique for delay in payment. Usually the insurance companies are more subtle than that.
So I suppose I deserve the :smack: for not being clear enough. It’s what I get for trying to post from my desk at work.
If the insurance company has a contract with the facility, they will be bound by it to pay claims in X amount of days. If not, the state should have a law governing how long they have to pay a claim. In Georgia, the insurance company has 15 business days to pay claims unless there’s a contract. If the contract allows for more time, but the insurance company exceeds this, then it reverts to the state law. (Your state may vary, of course)
However, if the insurance company needs additonal info (like medical records, accident info, etc) then the time frame starts over when they receive the info.
If the insurance company is stalling after all the info has been received, the facility CAN bill the patient.
The insurance company can’t delay forever, but they will delay as much as they can.