Texas doctors say restitution pay is meager

Insurers say physicians are getting less than they expected because they submitted unclean claims.

By Myrle Croasdale, AMNews staff. Dec. 17, 2001.

Texas physicians are seeing very little in late-payment restitution from health insurers, says the Texas Medical Assn. The Texas Dept. of Insurance says health plans paid $12.2 million in restitution, with $2.5 million going directly to physicians.

The department fined 17 health plans in August for failing to meet the state's prompt-payment laws. Restitution was added to fines of $10.4 million paid by the health plans for failing to pay clean claims within 45 days.

"The less than $2.5 million paid to physicians is a mere drop in the bucket of what is owed," said Tom Hancher, MD, TMA president. "Physicians are suffering severe cash-flow problems from these breach-of-contract denials of timely payments."

Some HMOs sent lump-sum payments with no indication which claims were being paid, he said.

The state insurance commissioner said the insurance department would launch new audits to make sure "HMOs and insurers are not simply reclassifying claims or using other sleight-of-hand tricks" to avoid paying doctors and hospitals.

The insurers filed reports Nov. 20 showing they had paid $12.2 million to 5,754 physicians and 4,235 hospitals and other health care entities. If the $2.5 million had been evenly distributed among physicians, each would have received $435. [...]