Keeping the fires lit on issue of prompt payment

AMA Leader Commentary. By D. Ted Lewers, MD. April 2, 2001.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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

Every now and then, one of my columns hits a raw nerve with physicians -- and February's column (AMNews, Feb. 5) on prompt payment was one of those columns.

On a single Saturday, I received between 30 and 40 e-mails from physicians nationwide -- as well as from practice managers, office administrators and even consultants. They all told their own version of a too-familiar story: insurance claims that "mysteriously" disappear in the mail, payment appeals that languish for months, and payment systems that, as one respondent put it, "would make Kafka proud."

Some of the physicians who wrote to me were closing or planning to close their practices because of payment problems. One of those physicians -- a solo family physician -- had $100,000 in unpaid claims.

These letters were vivid reminders that much work remains to be done on the prompt-payment front. But they also reaffirmed our decision to take a strong stand on this issue. In fact, the letters I received were overwhelmingly positive about the work the AMA and the Federation are doing together to ensure prompt payment of claims.

These letters made it clear that the AMA, along with state and county medical associations, must continue their efforts to get prompt-payment laws and regulations in every state, until every physician in America is protected.

These letters also made it clear that together we must work to strengthen existing laws and regulations, close loopholes, provide continued monitoring of insurers -- and increase penalties, so that the laws and regulations truly "have teeth."

It is apparent that, as a number of you told me in your e-mails and letters -- even in states where prompt-payment laws and regulations exist -- abuses continue.

Consider the story of an Oregon physician who wrote to tell me that he routinely bills for multiple services on a single HCFA-1500 form. Strangely -- or not so strangely -- only one procedure listed on the form gets paid. The rest of the charges, listed on that same form, somehow get "lost."

That's why the Oregon Medical Assn., as I reported in my February column, is working to get prompt-payment legislation on the books.

But what about the physician from Plano, Texas? His practice administrator submitted claims three times -- electronically, by fax and in person. Still no payment. Worse yet, the Texas Dept. of Insurance required the physician to provide proof that the claims had been filed electronically -- even though the insurance company did not acknowledge receipt of electronic claims.

The remaining options? Either produce a certified mail receipt or proof of delivery by courier.

The practice administrator remarked, "I suppose my greatest error was not videotaping the hand delivery of these claims!"

That's why the Texas Medical Assn. is fighting for stronger prompt-payment laws.

The frustration of the physicians from Oregon and Texas was echoed in letters from Arizona, California, Louisiana, Missouri and New Hampshire -- among other states. Cumbersome requirements for proof, numerous backlogs on unpaid claims, unanswered letters and phone calls, and -- perhaps most important -- insufficient penalties for third-party payers.

These are the problems that plague the physicians and staff members who dare to challenge the delay and no-pay tactics of health insurers across the country.

I am thankful that most of these physicians are ready to fight for what's fair -- just like your AMA.

We don't think your office should be functioning as a collection agency.

That's why we will keep working, together with the state and the local medical societies, to get prompt-payment laws and regulations on the books and to put teeth into the prompt-payment laws that are already in existence.

And, if necessary, we will take the matter further. In fact, with your state association in the lead, organized medicine will go to court.

Last February, the Medical Assn. of Georgia, the AMA/State Medical Society Litigation Center and three Georgia physicians jointly filed a lawsuit against Aetna U.S. Healthcare and its Georgia subsidiary. The charge? Disregarding the state's strict prompt-pay law.

Last May the California Medical Assn. filed a lawsuit against the state's three largest for-profit national health plans on several grounds, including delaying payments.

Most recently, the Connecticut State Medical Society filed a class action suit against the state's six largest managed care organizations on behalf of its members. The abuses they cite include delayed, denied and reduced payment of claims, among other serious problems.

So keep your state, county and specialty societies -- and us -- informed about your payment concerns. Fill out your state's prompt-payment survey if one is available. Contact your state medical association for complaint procedures and forms.

If you live in a state with prompt-payment laws, send your complaints to the insurance company in question and copies of your complaints to the appropriate state regulatory agency. Keep copies of these letters on file.

Finally, read on the Web site (http://www.ama-assn.org/ama/no-index/legislation-advocacy/9879.shtml) about how the AMA and the Federation can help you. And know that our Private Sector Advocacy group has made prompt payment a priority issue for 2001.

As the executive director of the Oregon Medical Assn. wrote to me just a few weeks ago: "If ever there was a poster child for why the Federation can and indeed must work positively and effectively for the physicians of this country, the prompt-payment initiative is it. In more than 32 years in organized medicine, I have never seen a more dramatic example of what Benjamin Franklin meant when he said, 'We must all hang together, or most assuredly we shall all hang separately.' "

Let me know what you think. E-mail me.

Dr. Lewers of Easton, Md., a nephrologist and internist, was AMA board chair during 2000-01.