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: the dark goddess of replevin speaks

dear director of patient relations

I am new to your organization, so I have been reviewing carefully all the forms that were mailed to me in advance of my first appointment.

[Of course, this isn't because I'm new. I will review carefully every form you ever hand me. Fair warning.]

I noted with interest the following language:

[This me trying to be tactful.]

"We allow 30 days from billing for your insurance company to make payment. If your account is not paid in that time, we will ask you for assistance to obtain payment from your insurance company."

You may only want to allow my insurance company 30 days to pay up, but as a matter of federal law, ERISA gives my insurance company 30 days to make a decision on a "post service" claim, which, if you are submitting billing to them, is what we are talking about here. They also might be able to ask for a 15-day extension in some circumstances.

What you seem to be saying to me is that unless my insurance company not only makes its decision on a shorter timeline than federal law gives them, but also gets a payment to you, you are going to start hounding me.

I assume that you are relying on the "prompt pay" statute in effect in your state in setting forth this policy. Prompt pay statutes haven't been faring well in federal courts lately, so there's a good chance that the whole thing is preempted by ERISA. Even if upheld, your statute doesn't give me a private right of action, and only requires my insurer to hit the target on 95% of "clean" claims. I could be in the five percent, and I have no control over whether the claim as submitted will be a "clean" claim as your state statute would require.

What I really want to know, as your new patient, is simply this:

How aggressive are you going to be about this language, given that you're a big institution, and my insurer is a big institution, and the dollars involved are more significant to me than to either of you?

Full post as published by the dark goddess of replevin speaks on October 17, 2016 (boomark / email).