Q: I recently received several requests from companies requesting I sign a document to negotiate payment on an insurance claim. Generally, it states that by signing the document, payment processing will be expedited, but I might not balance-bill the patient.
A: These requests are nothing more than a ploy to see if a provider is desperate enough to take a lesser payment that is paid slightly faster. They are a bad deal for the provider on two levels.
First, why should a provider have to agree to take less money than what is owed by the insurance on a particular claim and, on top of that, not be allowed to collect any balance? If the amount billed is fair and reasonable, the amount paid should also be fair and reasonable. Of course, this adjusting group typically states you will be paid within 10 business days. The reduction is for that "faster" payment. Considering most states have laws that require insurance payment from 15 to 45 days, I doubt this payment would be tangibly faster.
For example, let's say the reduction is 10 to 20 percent of your payment to receive it a month in advance. To take this offer would be fiscally foolish for your office. You're giving away a yearly interest rate of 120 to 240 percent. Imagine an investment that would pay 10 to 20 percent for one month; that would be some "bull market," to say the least. If you know of such an investment, let me know.
Of course, the insurance company has figured this out and is making money off you when you take this deal. I would bet these adjusting groups simply take a percentage of that as their payment. It's a very passive way of the carrier lining their coffers with your money.
Second, this could be considered extortion. Now, this is a strong statement but hear me out. When these agreements are sent, does the time frame for payment allowed by state law increase? No it does not. Claims still are to be paid within the set time frame, regardless of this request. However, I have found that when the doctor does not agree or respond to the documents, claims are not paid timely and do not include the interest (or any applicable penalties) the law mandates. When claims are followed up, carriers hide under the statement that it was not paid timely because of "no response" to the deal offered.
In other words, they will not pay in a timely fashion unless you accept their offer - sure sounds like extortion to me. The bottom line is that I would not accept this offer. I am not interested in giving them money to be paid a week earlier.
Click here for more information about Samuel A. Collins.