Nebraska hospitals say it’s getting harder to get insurers to pay – InsuranceNewsNet

Julie Lattimer had a pretty good experience with Glowing Health most of the time she had a health insurance policy with the company, so she was surprised when a routine $60 the lab charge was denied in August.

The lincoln woman said she was even more surprised by what the lab told her: Glowing Health was apparently not paying the claim because he had run out of money.

The Minneapoliswho started offering fonts in Nebraska through the Affordable Care Act Market in 2020, announced earlier this year that it would stop offering policies in most states, including NebraskaNext year.

This decision was largely due to the financial difficulties of the start-up, which reported a $1.2 billion loss in 2021.

It is not clear if other Nebraskanians insured by Glowing Health had a similar experience as Lattimer. The Nebraska Department of Insurance said he couldn’t comment Brilliant Health financial situation and whether he had received any complaints about the business.

But the company has had problems in other states. In April, Colorado a fine Glowing Health $1 million after receiving numerous complaints from residents about the insurer not paying claims in a timely manner.

In addition, nearly 200 complaints were filed with the Better Business Bureau on Glowing Health over the past three years, the majority of them related to unpaid claims or payments not received on time.

Lattimer said she spoke with a company representative who now says her claim will be paid, but it will take 30 to 60 days, meaning it will ultimately take four to five months to pay what she has. called “a tiny little claim”.

Glowing Health did not respond to a request for comment.

Whereas Glowing Health may be an anomaly in terms of the extent of its payment problems, hospitals and other healthcare providers report having more problems obtaining payments from the health insurance companies they work with.

“Overall, the insurance industry has slowed payments,” said Mike DeWerff, Bryan Health financial director.

DeWerff said he’s recently seen an increase in the time it takes for commercial insurers to pay a claim submitted by Bryan, which in the past has averaged about 50 days.

“I would say we’re up a bit, maybe five days, so maybe 10%,” he said.

DeWerff also said that lincoln-the system-based hospital system is seeing more and more claim denials.

In 2019, before the coronavirus pandemic, Bryan averaged about 800 insurance claim denials per quarter, he said. This number has increased to around 1,000 denials per quarter over the past two years and around 1,200 per quarter during the second half of this year.

“Refusals increased last year,” DeWerff said.

The most recent data from the National Association of Insurance Commissioners showed a slight increase in refusals last year, reaching 15% compared to 14.5% in 2020. However, this figure was still lower than in 2018 and 2019, when refusal rates were 16.9% and 15 .3%, respectively.

But a study by consultancy Kaufman Hall shows that refusals have likely increased this year. The study reported that two-thirds of hospitals reported an increase in the claims denial rate in 2022.

Bryan isn’t the only health care organization to report issues with health insurers.

Janna Clinefinancial director of Faith Regional Medical Center in Norfolksaid she was having more trouble with insurance companies and had seen the hospital’s relationship with some of those companies deteriorate.

“Insurers are really trying to lower what they pay us,” Cline said in a Zoom meeting last month with the Nebraska Hospital Association. She also noted that it is taking longer than before to get paid.

“We’ve had claims here internally that (are) 18 months old that we’re struggling to get insurers to pay for,” she said.

It’s not just late payments and denials of claims that plague hospitals.

“We are seeing more requirements for prior authorizations,” said Jeremy Nordquistpresident of the Nebraska Hospital Association.

When hospitals run into these hurdles, whether it’s pre-authorization, slow payment, or outright denial, they have to spend a lot of time and effort appealing or trying to get their money.

For DeWerff, that’s the biggest problem.

He said a health system the size of Bryan doesn’t feel that big financially. sting being paid a few days later.

What causes a financial burden is the number of employees Bryan must have just to deal with insurers.

DeWerff said the company is paying $2.5 million a year in salaries to 45 people who are just working on pre-approvals for care.

“Our biggest frustration is what we have to spend on the administrative burden,” he said.

Ivan MitchellCEO of Great Plains Health in North Platteagreed, saying the insurers’ tactics lead to “a bureaucratic mess by making it harder to get paid”.

He denounced what he said were “a lot of bad players in health care right now,” pointing to private companies participating in the government’s Medicare and Medicaid programs.

For example, Mitchell said the three Medicaid-managed companies that Great Plains works with “all find different ways to deny claims.”

He also called Medicare Advantage, which is a system in which private companies bundle Medicare benefits into a package and add certain benefits, “Medicare Disadvantage”, and said these companies are also looking at ways to deny claims and not provide the services they promised.

The state Insurance Department aggregates all complaints against insurance companies, so it’s hard to know whether there have been more complaints about health insurers, but it’s possible, as overall insurance complaints are on the rise.

As of Wednesday, the department had reported 498 complaints so far this year, more than in 2020 or 2021, though that’s well below pre-pandemic numbers.

US health insurance plans, a trade group that represents health insurance companies, did not respond to a request for comment for this story. But in a May letter to Medicare and Medicaid Service Centersits president and CEO defended the practices of companies that offer Medicare Advantage plans.

“We are fully aware that some provider organizations would prefer that all clinicians receive a blank check to order a test or procedure at any time, regardless of the value or expected expense to the patient,” Matthew Eyeles wrote.

“But giving clinicians carte blanche is not a way to improve affordability and access to health care for every American — and we’ve known for decades that more medical care doesn’t mean better care.”