DAILY MAIL CAPITOL REPORTER
Many doctors and hospitals are sick of health insurers andmanaged care providers in West Virginia taking months to paypatients' medical bills and now want legislation to force thecompanies to pay on time. The worsening financial burden of latepayment threatens the state's health care providers, said WilliamMacLean, executive director of Health Partners Network, anorganization that includes 12 hospitals and 760 physicians in thestate.
The pattern of late payment is creating 'a chilling effect' withmore physicians reluctant to join managed care outfits, MacLean toldan legislative interim committee Monday.
And if the doctors he represents are suffering, he said 'I hateto think what private physicians are facing in their environment.'
He asked legislators to pass a 'prompt pay' bill that would set atime limit for insurers to pay patient bills.
Similar legislation exists in 39 states.
Regionally, prompt pay laws range from a restrictive policy foundin Pennsylvania to a less stringent arrangement in Maryland.
Both insurance companies and the state's Insurance Commissionhave agreed to try to work something out. The bill is expected tocome up at the Legislature's regular session early next year.
MacLean said he's 'not advocating onerous regulations' like inPennsylvania, but doctors and hospitals 'just need a little bit ofhelp.'
He would like to see West Virginia pass legislation similar to abill in Maryland, which enforces a 45-day pay period. He saidPennsylvania's law is 'too heavy-handed' and might scare off healthinsurers from entering the market.
Rather than fight legislation, health insurance companies arewilling to work out a bill 'that is acceptable to everyone,' saidRandy Cox, a lobbyist for the HMO Association of West Virginia andthe Health Insurance Association of America.
'If it's a balanced bill, my clients can live with some sort oftime limit,' Cox said.
Managed care companies, including HMOs, are among the worst atpaying on time, according to statistics of payments at UnitedHospital Center, a West Virginia University Hospital.
So far this year, bills of patients using managed care companiesremained unpaid for an average of 74 days, MacLean said. Blue Crosstook an average of 43 days to pay up.
Other commercial providers took 72 days.
But with large numbers of patients using managed care companies,the delays are especially troublesome.
Unpaid bills from managed care companies alone stack up to totalabout 20 percent of the $35.1 million in current assets at UnitedHospital Center.
MacLean also asked for so-called 'clean claim' legislation, whichwould require insurers to pay claims that include all the necessarypatient information.
MacLean said it's 'relatively common for there to be a protractedprocess of determining if a claim is clean.'
Some insurers are merely being 'tough editors' of claims, MacLeansaid, but other outfits are just trying to keep their money longer.
He estimated that about one-third of questioned claims arejustified, while two-thirds are just 'red herrings.'
MacLean pointed to the state's Medicaid program as the paradigmof prompt payment of bills.
Medicaid, the state's largest health insurer, processes 15million invoices a year, but pays 90 percent of its bills within 30days and 99 percent in 90 days, said Phillip Lynch, Medicaid'sbudget director.
'Quite frankly,' MacLean said, 'if everyone paid on thatschedule, I wouldn't be here.'
Writer Todd C. Frankel can be reached at 348-4886 or by e-mail attcfrankel@dailymail.com.
