Insurer blames computer woes for late payments in Kentucky : LUSENET : TB2K spinoff uncensored : One Thread

Saturday, April 29, 2000

State begins probe of Anthem, others


The Courier-Journal

The Kentucky Department of Insurance launched a formal investigation yesterday to determine the extent of late payments by Anthem Inc. to doctors' offices, most of them in the Louisville area.

The investigation also will include other insurance companies that physicians say have not paid claims promptly.

Roger Snell, an Insurance Department spokesman, declined to name those firms, saying that they hadn't been notified that they are being investigated. Letters to them were mailed yesterday, he said.

There's no way to predict what the investigation will find, or what action, if any, might be taken against Indianapolis-based Anthem and the other insurers, Snell said.

He noted that the department can impose penalties, and that a Paducah-area insurance company last year was fined $40,000 for misleading consumers by excluding some doctors from its provider list.

The department can also require companies to pay interest at an annual rate of 12 percent for all mistake-free, or "clean," claims that are not paid within 30 days.

Snell said Anthem is cooperating in the investigation.

Anthem has made some records available to state investigators and will provide figures on how many doctors haven't been paid and the total dollar amount of unpaid claims, said Suellen Brill, a company spokeswoman.

"We want to make a good-faith effort to get this issue resolved and move forward," she said. The late-payment problems, Brill said, were the unintended result of the company's conversion to a new computer system that began last October. Delays started showing up when thousands of members were switched onto the new system in January.

According to the doctors, the total amount Anthem owes may be huge.

Dr. Rebecca Booth, a member of the seven-physician practice called Women First that filed a formal complaint against Anthem earlier this week, said the insurer owes them $880,000. Some of the claims are 120 days old, she said.

Brill declined to say how much Anthem owes Women First.

Booth met with state insurance officials yesterday morning and provided records of hundreds of claims that investigators will be reviewing in their inquiry.

IN AN INTERVIEW yesterday afternoon, Booth said she knows of several other medical practices that are waiting for payments of nearly $1 million from Anthem.

Trying to run an office without money to cover expenses, she said, "just gives you a trapped feeling. I am encouraged, though, and I hope the state will help. We know what we've done, and we know the patients we've treated, and we know no money is coming in."

Booth said Women First employs more than 30 people.

The first thing investigators will do, Snell said, is try to resolve a "substantial factual dispute" about exactly how much Anthem owes Women First.

"It's a major disagreement," he said, with Anthem claiming it wrote a check "for six figures" to Women First in the past two weeks.

"They say they never got it," Snell said.

No matter what amount the state investigation determines is owed, Snell said, Insurance Commissioner George Nichols III "is going to insist that a check be cut to them (Women First) in that amount as soon as possible."

Earlier this week, Paul Jennings, head of The Physicians Inc., an organization that represents doctors with insurance companies, said several hundred of TPI's 1,900 members had called complaining of late payments from Anthem.

The complaints involved "several million dollars," Jennings said.

He said he believes Anthem is making a sincere effort to pay doctors, offering to write checks before it actually processes the claims.

Like Booth, whose Women First group belongs to TPI, Jennings said that "other doctors are owed as much as Women First, absolutely." He said he welcomed the state's decision to look into the late payments.

The department's investigation comes amid growing attention nationwide on the issue of late payments to doctors and the problems they cause.

The Kentucky General Assembly passed a prompt-payment bill during its recently concluded session, and Gov. Paul Patton signed it into law earlier this month.

DR. HARVEY CARLOSS, a Paducah oncologist and president of the Kentucky Medical Association, said yesterday that the state's investigation of Anthem may be seen as "too little, too late by some people. But we're glad there's attention being focused on the problem, and we hope all sides can work together to solve it." Carloss and other physicians have questioned whether some insurance companies intentionally delay payments to collect interest on the money. Insurance companies, including Anthem, deny that.

-- A story to keep (an@eye.on), May 01, 2000

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