Prompt Payment / Payment Hassles

Delayed payments severely hinder physicians’ ability to keep their practices afloat. These delays also increase the cost of health care for patients and put billions of dollars in the “pockets” of health insurers as they earn cumulative interest on every late claim.

The AMA is fighting on your behalf to curb abusive practices by health insurers. We battle against delinquent health insurers to defend physician rights by frequently collaborating with regulators and legislators. Our goal is not only to enact meaningful laws, but to make sure that these laws are enforced by state regulators. A top priority of the AMA is to get physician claims paid – in full and on time. One of the AMA's top priorities is to get physician claims paid in full and on time.

Learn more about the AMA's efforts to help physicians file claims accurately and efficiently and receive timely and accurate payment from health insurers the first time through its "Heal the Claims Process" campaign.

The AMA's Practice Management Center has developed a number of educational resources and practical tools to help physicians and their practice staff combat late payment by health insurers.

Prepare accurate claims and file electronically.
Continue to accurately prepare your claim forms so health insurers can expedite their claims processing and payment process. We encourage all physicians to submit claims electronically to help cut down on processing times and errors. The AMA has developed two resources, “Prepare that Claim” (PDF) and The benefits of electronic claims submission - improve practice efficiencies  (PDF) help physicians and their practice staff review the efficiency of your current internal claims management process and to understand the many benefits that may be realized by submitting claims electronically to health insurers.

Know your state law.
To find out what your state prompt pay law is, view the prompt pay laws chart (PDF) compiled by the AMA’s Advocacy Resource Center.

Appeal inappropriately delayed claims.
The AMA developed the interactive resource “Appeal that Claim” (PDF) to simplify the claim audit and appeals processes for physicians and their practice staff. This interactive resource can help reduce the administrative burden by delivering a step-by-step course of action to appeal an underpaid, delayed or inappropriately denied claim. The AMA has also developed several appeal template letters in regards to prompt payment.

File a complaint.
If a claim has not been paid in accordance with your state law and is untimely, follow the requirements for notifying the respective state agency of the violation. View the AMA's interactive map to learn the complaint process for your state. You can also fill out the AMA Health Plan Complaint form.

File a compliance dispute.
Find out what settlement provisions were agreed to in the Blue Cross Blue Shield and MDL settlements.

No matter how comprehensive state laws and advanced complaint reporting processes are, they are only helpful if physicians take advantage of them. State laws are not effective on their own. Remember that the laws were developed to protect you and your patients from the abusive payment practices of health insurers. Patients and their physicians deserve nothing less than to have their bills paid in full and on time.