Issues With Updating Contracts Can Lead to Payment Issues

Several hospitals and commercial health insurance companies have been in the news lately as they attempt to work out new contracts. Although the articles have been clear that patients will be facing steep increases should things head to an impasse or even if the health insurance companies win the dispute, what has gone unsaid is the fact that payment issues can arise between both parties. Hospital billing departments already have enough on their hands without the possibility of additional disputes popping up on the horizon.

HRS Case Review

Facing Issues When Updating Contracts

Currently, UMass Memorial and United Healthcare are locked into a contract dispute. According to the experts, “UMass Memorial’s contract with Cigna for Medicare Advantage members is slated to expire Dec. 31. UMass Memorial providers treat about 820 Medicare Advantage members with UnitedHealthcare coverage.” The main issue is, of course, rates, “Reimbursement rates are central to the disagreement. UMass Memorial had argued it can’t accept UnitedHealthcare’s rates because they aren’t in line with what other regional Medicare Advantage plans pay. UnitedHealthcare, on the other hand, said UMass Memorial is refusing to accept traditional Medicare rates or undergo a quality review, which is derailing the talks, according to the report.”


How Do Updated Contracts Lead to Payment Issues?

Once the contract issue has reached a conclusion, the next problem lies within the billing department. Or, to state that more clearly, with the commercial health insurance company’s claims department – the people who are supposed to pay those claims through the hospital billing departments. It’s far too easy for the insurance company employees to deny claims or short-pay them under the guise of the new contract, even if that care took place under the previous one. As a result, the hospital ends up with even more unpaid aging claims than usual. This isn’t good. Thankfully, there’s a solution.

How Federal ERISA Appeals Can Help

According to Federal ERISA law, these claims must be paid. While most hospital and clinic billing departments aren’t able to handle Federal ERISA appeals, because they either are too busy dealing with current billing and state-level appeals to process the aging claims or they simply were never trained on how to do ERISA appeals (which is often the case), there are specialists out there who can take on the challenge. ERISA Recovery is one of those companies. If you have aged claims, rather than place them in your debt bucket, get them cleared up. Every penny counts in healthcare. Contact us today to get those aged claims cleared up.