Thursday, September 24, 2009

My View of H.R. 3200 continued (this could take a lot of blogging)

I've continued to read the H.R. 3200 bill and have come across another crucial piece that I'm liking quite a bit. That's the "timely payment of claims" portion. I'm not sure if it only applies to the national payor or to all private insurance in general. I've billed medical insurance for thirteen years. Medicare always paid timely, you just had to make sure you had the following: Certificate of Medical Necessity, qualifying diagnosis, every little box that needed to be checked, properly would usually see a turn around of about 4 to 8 days. Private insurance on the other hand, usually needed a preauthorization, then an authorization, then a participating physician, a prescription, and had to be filed within 30 to 90 days depending upon the carrier.

Blue Cross Blue Shield was notorious for "never" receiving the claim. And unless you had a good aging report that caught these unpaid claims quickly, a lot of times you'd be out of luck, because then you'd be out of timely filing. With medicare, you have 18 months to file the claim. Why so long? Well, sometimes a service may be provided in the emergency room, by a resident or visiting doctor. That doctor is the attending and ordering physician. If that doctor is visiting he/she may not be there anymore when you send the certificate of medical necessity for his/her signature. That's when the real fun begins...tracking down that doctor. So, if this bill requires private insurance to follow in the steps of medicare then that will be a big improvement in our healthcare system.

Here's a part of the bill that I think answers or quells all those people screaming that we won't have access to doctors:

No Restrictions on Coverage Unrelated to Clinical Appropriateness- A qualified health benefits plan may not impose any restriction (other than cost-sharing) unrelated to clinical appropriateness on the coverage of the health care items and services.

I'm not seeing where there will be long lines of people just waiting to see the doctor. I'm also not seeing where people will be denied preventative maintenance, yearly check ups or delay in getting treatment. I know I got lots more to read, but so's good.

No comments: