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California Fines Health Insurance Carriers for Underpayment and Delay of Claims-Should Fine Congress for the Medicare Delay In J

Posted Nov 29 2010 8:42pm

Pay and continue to pass go certainly seems to be the rules of the game today.  All the major health insurers in California took at hit it seems and it all comes back to getting the data system aligned.  They get stuck in cyber space when they do not fall in accordance with the algorithmic formulas that sort and approve claims based on parameters and when those are being changed, well there’s one more issue. 

As I stated in the title here I’m working on claims that were submitted to Medicare that failed due to an Unrecognized technical error, in other words it was too much to work on from the end of the Medicare contractor, Palmetto in this case who is a wholly owned subsidiary of Blue Cross, and have folks resubmit.  This time in June when Congress let the10 day buffer flow through, data systems needed to be reset to cut the checks t at the lower rate as they failed to act in in time.

How about that time and money those folks in Congress cost everyone and I was not alone, had several tweets telling me that tons of claims too, so again data illiteracy and the rules of  cause and effect, especially with the GOP causes everyone a lot of extra work and frankly to have folks without general consumer digital literacy making laws, scares me to death as they think they could do the same for healthcare repeal?  Give me a break and get some smart people to help those folks who don’t realize the need some Algo men to explain that everything has a system and that IT infrastructure costs money. 

On the same hand here, insurers need to get their algorithms together too as if they do not complete a process they sit in cyberspace or if a denial needs extra attention, get it done and don’t just let it sit there as that happens.  Unless someone runs a process to check out all the non completed claims, etc. then they just kind of sit there.   Every carrier and Medicare are very complicated and frustrating to deal with when it comes to billing as that is the nature of the beast they built.t.  BD 

The health plans also must provide restitution to hospitals and doctors for delayed and underpaid claims going back two to three years, which could reach tens of millions of dollars, according to the California Department of Managed Health Care, which oversees HMOs and issued the fines. Insurers must also change their claims paying practices.

Anthem Blue Cross, a WellPoint subsidiary, and Blue Shield of California, a not-for-profit independent insurer, each were fined $900,000; UnitedHealth Group/PacifiCare was fined $800,000; Health Net and Kaiser Foundation Health Plan each were fined $750,000; Cigna was fined $450,000; and Aetna was fined $300,000, for a total of $4.85 million.

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