Saunders, Real Estate, Hamptons

1 Comments by medbiller

Hospital talks at impasse; Bishop threatens to call for investigation

I have been in the healthcare field for over 30 years, a biller for 15 years and in fairness to all THREE sides of this problem, Why is there an issue to the reimbursement rates of Empire Blue Cross/Wellpoint? This could be due to a number of causes. The first one being the payment rates are to low for hospital reimbursement in comparison to other hospitals within a certain radius. In my previous experience in dealing with Empire Blue Cross, it was stated to me by an Empire Blue Representative, "We don't have to negotiate, we're 30 million strong". Second, possibly due to the lack of adequate staffing in the reimbursement department of these hospitals or the lack of knowledge of the staff and the rules of reimbursement, therefore showing the lack of payment by Empire Blue which could increase the accounts receivable (unpaid claims) for this insurance company. If the hospitals are looking for an increase of their Empire Blue rates to compensate for this problem, this is wrong. This would result in the THIRD side as being an increase in Empire Blue rates to the working and unemployed/ non-working to compensate for the above problem. If these issues are not investigated correctly, the patient will again, end up paying for this problem as with other insurance company negotations in the past. This issue is not unique to Empire Blue Cross/Wellpoint. This problem encompasses all insurance companies, all hospitals, all doctors offices. The end result is the patient paying more and/or receiving less. Patients also share some of this responsibility as they DO NEED TO KNOW THEIR INSURANCE POLICY requirements for treatment.May the correct answers be found. What ever happened to getting sick and being treated without the runaround." Jul 23, 09 12:10 PM