by John Yodonise

January 11, 2017

Why Does It Take So Long For Claims To Be Paid Graphic

Did you ever wonder why it takes so long for claims to be paid?

Here is a great video on the multitude of issues as to why it takes so long for your claims to be paid. Unfortunately, it is a conversation we have far too often with many patients who just do not understand how the process works.

 

We can definitely relate to many of the issues that cause delays in claims to be paid.

  • Faxing documentation is a very common issue, even though we get a fax confirmation, the insurance companies deny receiving the fax.
  • Customer support is almost impossible to reach, wait times of an hour or more are becoming common. Some insurance companies actually ask you to make an appointment to talk to support people.
  • If you are lucky enough to reach customer support, they immediately tell you to go to their portal for information.
  • If you are lucky enough to get customer support to talk to you, they use a script and if your problem does not follow the script, you are out of luck.
  • Verification of benefits are not worth the paper they are printed on and cause many problems for patients who are quoted incorrect information. If you don't have this memorized yet, you should because you will hear it often. "Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility, any claims received during the interim period and the terms of the member’s certificate of coverage applicable on the date services were rendered."
  • Several companies have sent customer support overseas and heavy accents make it difficult to communicate with them.
  • Claims are denied and when you call and ask why it was denied, they are unable to tell you and cannot tell you how to fix the claim to get it paid.
  • The insurance companies are updating their computer systems and running into multiple problems.
    • One company changed their authorization requirements but forgot to update their computer system so claims were rejecting that were valid for months.
    • The new Physical Therapy Evaluation codes were being rejected by the Clearinghouse for 5 days after they went into effect because they did not update their systems.
    • One company changed their address for paper claims but never notified anyone of the changes until you received the mail back and called them to find out why it was returned.

So watch the video and find out why it is taking so long for your claims to be paid! This is why submitting clean claims that get processed the first time is becoming even more important than ever.

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