A spike in complaints about health insurance companies withholding reimbursement payments to Missouri-based health care providers has prompted an investigation by the state Department of Insurance.
Gov. Jay Nixon has ordered the department to determine whether stalled reimbursement payments are a systemic issue in light of increased complaints from physicians, hospitals and other health care providers that insurers are not paying the bills in a timely manner.
"We think this is almost a universal problem with providers," department spokesman Travis Ford said, adding that some cases are particularly egregious. "We have hospitals in St. Louis that are owed millions of dollars."
Other examples include a rural hospital in eastern Missouri waiting more than two years for $300,000 in reimbursements and a small anesthesia practice in central Missouri that filed a complaint regarding almost $120,000 in outstanding claims dating back to 2007. The Department of Insurance was unable to provide specific examples of complaints filed by Springfield area providers.
Missouri health care providers have filed 303 complaints about tardy reimbursement already this year, compared to 196 last year and just 41 in 2007, according to the department. Complaints lodged by Springfield health care providers have mirrored the statewide trend: There have been 15 so far this year, compared to seven last year and only one in 2007.
Nixon's executive order directs the Department of Insurance to survey hospitals and care providers statewide to determine the extent of the issue. Ford said the department has to complete its review by Dec. 31, at which time the findings will be turned over to the governor and General Assembly.
Ford reminded that a single complaint doesn't necessarily represent a single unpaid claim. In some cases, a complaint may encompass multiple claims -- possibly hundreds, he noted. And some insurers have surfaced in numerous complaints, Ford said.
"There are a lot of repeat offenders," he added.
State law requires health insurers to respond to and pay valid claims to care providers within 45 days, and those that don't face penalties and interest payments, Ford said. Enforcement of so-called "prompt pay" laws is handled through the Department of Insurance. Health care providers seeking payment also may pursue civil litigation.
The Missouri Hospital Association is urging lawmakers to strengthen the state's prompt pay laws with stiffer penalties for insurance carriers that fail to reimburse health care providers within 45 days, said MHA Senior Vice President Mary Becker.
"It can be a significant burden, not only on hospitals, but physicians as well when they have their claims held up," she said. "Under current laws, the insurers can hold a claim for any reason if they have a question about it. There's no window in which they have to specify what that is."
Becker said the MHA isn't sure what's driving the rise in complaints.
"You can only think that perhaps it's just hanging on to the money a little bit longer," she said.
The Department of Insurance has asked health care providers with complaints about slow payment from insurance companies to call the Insurance Consumer Hotline, (800) 726-7390, or visit www.insurance.mo.gov.
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