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Dynamic Chiropractic – June 3, 2008, Vol. 26, Issue 12

Negotiating for Timely Reimbursement

By Samuel A. Collins

Q I have recently received several notices from companies such as MultiPlan, Health Resource Group and National Health Quest, all requesting I sign a document to negotiate being paid on an insurance claim.

Generally, it states that signing the document will expedite processing of payment, but that I may not balance bill the patient. It also seems to be reducing the amount that typically would be reimbursed. Is this something I must or should sign?

A These requests, in my opinion, are nothing more than a ploy to see if a provider is desperate enough to take a lesser payment in return for being paid slightly faster. I think they are a bad deal for the provider on two levels.

First, why should a provider have to agree to take less money than what is owed by insurance on a particular claim, and on top of that, not be allowed to collect any leftover balance? If the amount billed is fair and reasonable, the amount paid also should be fair and reasonable. Of course, this adjusting group typically states you will be paid within 10 business days and the reduction is for that "faster" payment. Considering most states have laws that require insurance payment within 15-45 days, I doubt this payment would be tangibly faster.

For example, let's say the reduction is 10 percent to 20 percent (usually higher) of your payment to receive the payment sooner, and let's further stretch it and say the payment comes a month sooner. To take it would be fiscally foolish for your office. You are giving away annual interest rate of 120 percent to 240 percent. Imagine any investment that would pay 10 percent to 20 percent for one month - that that would be bull-market stock, to say the least, and if you know of one, let me know. Well, of course the insurance company has figured that out and is making money from you when you take this deal. I would bet these adjusting groups simply take a percentage of that as their payment. It's a very passive way for carriers to line their coffers with your money.

Second, I think this could almost be considered extortion. That's a strong statement, but hear me out. Because these agreements are sent, does it increase the time frame for payment set by state law? No, it does not. Claims are still to be paid in a timely fashion, regardless of this request. However, I have found when these documents are sent and the doctor does not agree or respond, claims are not paid timely and do not include the interest or any applicable penalties the laws mandate. When claims are followed up, carriers hide under the statement that it was not paid in a timely fashion because of lack of response to the deal offered.

In other words, they are not paying timely unless you accept their offer, which sounds like extortion. I am aware of some Texas chiropractors who are gathering information to prove this is a common method of practice by several insurers.

The bottom line is that I would not accept this offer. I am not interested in giving the insurer money to be paid a week faster. What if consumers sent a letter to insurers stating they will pay only 75 percent of their insurance premium to pay it on the first of the month instead of the 15th? I don't think insurers will go for it, do you?

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