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News of the Day ... In Perspective

05/27/2006

Insurers’ tardiness, inappropriate refusals, add up to 20% to physicians’ overhead

A survey of health insurance claims filed late in 2005 suggests reasons why commercial insurers are doing well while doctors struggle.

Insurers “lose” up to 1.3% of claims (even some for which there is a return receipt); keep doctors’ staff on hold for 30 minutes; limit the number of questions that can be asked in a single call; or simply deny claims physicians believe to be legitimate.

Claims filing difficulties add up to 15 to 20% to physicians’ overhead in the estimation of Jack Lewin, chief executive of the California Medical Association.

The quickest time between medical service and payment was 29.0 days for Humana, and the slowest 41.4 days for Champus/Tricare.

Insurers blame doctors’ offices for submitting wrong information.

Various measures of performance for large insurers are posted for public viewing by Athenahealth, which helps doctors and hospitals get paid by editing their claims, at http://www.athenapayerview.com. Insurers complain that the results are not statistically valid (Milton Freudenheim, “The Check Is Not in the Mail,” NY Times 5/25/06).

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