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Insurers must pay on time -- or pay the consequences

AMA Leader Commentary. By D. Ted Lewers, MD. Feb. 5, 2001.

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AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from D. Ted Lewers, MD, chair of the AMA Board of Trustees.

Do you feel as if your patients' insurance companies stall as long as they can in paying what they owe you? You're not alone, and now a number of state and local medical societies have data to prove it -- and plans to change the way insurers do business with you.

Delayed, deferred and defaulted payments are, of course, hardly news to us. "The check is in the mail" has been the unofficial motto of a number of insurers for years. What is relatively new is that physicians, through state and county medical societies, and with help from your AMA, have been fighting back. Effectively.

Take a recent headline case in Oregon. After customizing and circulating a template survey developed by the AMA, the Oregon Medical Assn. has evidence to prove what its physicians have long known: Many insurance carriers are not obeying Oregon's payment regulations.

Current Oregon regulations require insurers to accept or deny claims within 30 days. However, the state does not penalize insurers when they fail to comply. Not surprisingly, the OMA's survey shows that Oregon physicians wait an average of 40.5 days before receiving payment on claims -- and many wait even longer. The study also indicates that these delays appear to be an industrywide phenomenon -- not just the problem of a few companies.

Survey participants also reported another disturbing problem: so-called "lost" claims. Nearly nine of 10 practices reported that they had submitted claims only to have insurance carriers maintain that the claims had never arrived or had been lost. The physicians were thus compelled to resubmit claims and wait several additional weeks for payment. [...]