Third Pary Companies Trying to Reduce Your Reimbursement

One of my providers received a phone call today from a man who represented himself as someone who wanted to release a check to her for services she had provided to a patient, but he just needed to fax her a paper to sign. She got the paper and didn’t understand what it was, so she faxed it over to me, Thank GOD!

I’ve been seeing this over the last year or so. A third party company comes in and gets claims from an insurance carrier. Then they contact the medical provider and try to get them to sign an agreement which basically claims that if they agree to accept a reduced fee, they will get reimbursed quicker! What a crock!

First of all, it doesn’t seem legal that these third party companies can obtain these claims from the insurance carrier. I would think that it breaks some kind of confidentiality. And second of all, an insurance carrier is suppose to process a claim within 45 days of receipt of the claim. If the claim is just for fairly common services, and all the information on the claim is accurate, the claim should be paid in a timely manner anyway. And besides, I’ve found that by the time they contact the provider and try to get them to sign the contract and then finally pay the claim, the same amount of time has passed that it would normally take for the claim to be processed by the originally carrier.

Besides, why should the provider take a cut in pay? The latest one I received was a 26% reduction from the approved amount. And the incentive is something that is suppose to happen anyway? Timely payment for the services? Doesn’t really make any sense to me!

I always advise my providers to just say NO! Do not agree to reduce your fee. We call the original insurance carrier and inquire as to why the claim isn’t paid yet. And we call and/or fax the third party company to advise them that the provider is NOT going to participate in their game.

So if you’ve ever been contacted by one of these third party companies requesting that you accept a reduced fee and you don’t feel like paying somebody who has nothing at all to do with the service you provided, then tell them thanks but no thanks! After all, you are already forced to accept the fee that the insurance carrier feels is reasonable for the service you are providing. Why should you take another cut in pay!

When we submit claims electronically, which most claims go electronically these days, over 90% are paid within 2 weeks. That basically makes this offer a “take a cut in pay so we will pay you in the same amount of time” offer. Doesn’t sound like a deal to me!