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Timely filing of health claims = health insurers rip off of providers and patientsApril 13, 2009

Posted Nov 04 2009 10:08pm

Why is it that a service provided can be denied payment simply because the bill is late?  This seems to not hold true for the IRS, most vendors, suppliers, providers of other goods and services.  However, when it comes to medical providers, most often hospitals and physicians (as well as other health care providers) health insurers have been allowed, with the blessing of state insurance commissioners, to create arbitrary and capricious time lines for the filing of claims for payment.  If the claim is not filed within this time frame, no matter its size or validity, it will simply not be paid, even though the service WAS provided.  Anybody think this sounds a bit lame?  Just another way for health insurance to avoid payment of claims? This site does.  One of the key tenets of REAL HEALTH REFORM must be health insurance reform – it must lead the way.  Timely filing rules, if they are to exist at all (and we would strongly argue they should not) should be relaxed and uniform to allow health providers and patients to deal with the insurance maze they often face. Medicare, Tricare (military) and Medicaid are among the most fair in this regard (usually with one year filing deadlines; and retroactive enrollment policies in the case of Medicaid).  Certainly this “scam” needs to be put in its place.  It is doubtful that 50 state insurance commissioners, all with political interests being brought to bear on them, could effectively resolve this.  Timely filing needs to be derailed as a means to deny payment for just claims . . . timely filing reform needs to be part of health reform . . . and most ideally, it should be eliminated as a cause for non-payment all together . . . obi jo

Health insurers and plans are always finding ways to invent not paying a claim.  One of the most popular claim denials is denying a claim that is “untimely”.  Most health plans have a defined time period on which to submit a health insurance claim and if the claim arrives beyond this date, the claim is denied.  A claim appeal is used to override this very common denial.  However, the time frame may and usually does vary among carriers (60 days to as much as 365 days).

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