Practice Management Articles
How Your State Insurance Commissioner Can Help
Linda Lindsey, CMIS, CMOM, CCP
Q. We are struggling with one insurance carrier who never pays claims on time. What can we do to get them to speed up payments?
A. If an insurance company is continually a slow payer, a method to speed up payments is to include a note to the carrier stating they have 30 days to pay or deny the claim, or a formal written complaint will be filed with the state insurance commissioner. You state's insurance commissioner handles the following types of disputes:
- Improper denial of a claim or a settlement less than indicated by the policy.
- Delay in settlement of a claim
- Illegal cancellation or termination of an insurance policy.
- Misrepresentation of premiums paid to an agent or broker.
- Misappropriation of premiums paid to an agent or broker.
- Two companies cannot determine which is primary.
Requests to the insurance commissioner must be in writing. In some states, the insurance commissioner requires that the complaint come from the patient even if an assignment of benefits has been signed. You may want to prepare a form letter for the patient to sign and then submit. Depending on the situation, you may want to send copies to the state medical association and/or an attorney. Mail may be sent certified, return receipt requested. The request should contain the following information:
- The inquiring person name, address and phone number
- The policyholders name, address and phone number if they are not the inquiring person.
- The name and address of the insurance company, broker or agent.
- The policy effective date.
- The policy or claim number.
- The date of loss.
- A statement of the complaint, if possible a copy of the policy, medical bills, unpaid insurance claim, cancelled checks and any correspondence from the insurance company pertaining to the claim.
- The commissioner's responsibility is to the patient, not the physician, therefore the letter must include the patient's signature, address and phone number.
If an insurance company pays the patient directly, even though the physician has accepted assignment and signs such a statement, file a complaint with the insurance commissioner. The commissioner will write to the insurance company and request a review of the claim. If the insurance company admits they violated the assignment, the insurance company must pay the physician within 2-3 weeks. This will be done even if they have not recovered payment from the patient.