BUSINESS

Insurers say prompt pay not a big issue; doctors disagree

Prompt payment isn't a main-stage issue for some regulators, yet doctors in some states still want more enforcement.

By Robert Kazel, AMNews staff. Sept. 15, 2003.

Prompt-payment laws are on the books in 47 states, but examples of state insurance commissioners using their most powerful weapon -- punitive fines -- are relatively rare.

Some state insurance commissioners view prompt-pay enforcement as a priority, but others say it's become a back-burner issue, especially because they perceive doctors to be not focusing on the issue as much as in the past. Challenges such as tort reform and Medicare rates have moved closer to doctors' center of attention, some regulators said. In other states, payment laws continue to be undermined because they're vaguely written and weakened by loopholes.

The Illinois Dept. of Insurance received more than 6,300 complaints about health insurance last year but only 191 -- 3% -- were about late payment of claims, said Bill McAndrew, spokesman for the agency. The state has the power to issue fines against payers but has not. "The number of complaints has not risen to that level where it would set off alarm bells on a particular company."

The insurance industry argues that the increasing number of doctors who've started filing claims electronically over the past few years has speeded turnaround of claims and made the laws less relevant. And, they say, their numbers show most claims are processed within legal time limits.

In a recent survey of payers by the Health Insurance Assn. of America, health plans nationally reported that nine out of 10 claims are processed within 21 days of receipt.

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