Doctors feeling insurance pinch

The Nevada State Insurance Commission is about to crack down on deadbeat health care insurers who are excessively late in paying doctors for services rendered.

As reported Wednesday by Las Vegas One, a 24-hour cable television news station, some insurance companies and third-party administrators who self-insure are at times anywhere from 90 days to six months late in paying claims.

"Our law says it has to be paid within 30 days," Guy Perkins, supervisor of the Life and Health Section of the state Division of Insurance, said. "Doctors have to live to a certain extent on their billings and cash flow. When insurers don't pay, it's difficult for them to provide services."

Perkins said each day his office receives complaints from doctors saying insurance companies, health maintenance organizations and self-insuring employers are past due in paying bills. He said one doctor's office in Las Vegas had between $250,000 and $300,000 in outstanding accounts receivable.

The Insurance Commission formed a subcomittee last month to study the problem, Perkins said. The state agency plans to strongly advise insurers to pay physicians' claims in a timely fashion, Perkins said.

If payment practices don't improve, Perkins hinted that action could be taken to suspend some insurance providers' state licenses.

"As we do in-house chemotherapy, we have to purchase medication first," Frederick Waid, executive director of the Nevada Cancer Center, 1980 E. Desert Inn Road, said. "If we are waiting from 90 to 120 days, that becomes problematic.

"Physicians front the cost for medications and equipment and paying staff. If we are the last ones to get paid, this becomes dangerous."

Ria Marie Carlson, vice president of public relations for Sierra Health Services Inc., says her company pays more than 50 percent of their claims within 14 days and 90 percent within 30 days.

"Those that remain," she said, "are waiting for more information, or the paperwork wasn't filled out right, or we need medical records."

Carlson said Sierra Health Services pays on average 20,000 claims a week.

Dr. Mitch Keamy, president of the Clark County Medical Society, said insurers aren't systematically late, but tend to be late depending on their financial conditions at certain times of the year.

"Physicians' cash flow is dropping," Keamy said of current trends. "Physicians' overhead is going up, and this causes them to feel they aren't being compensated. I applaud the insurance commissioner (in forming the subcommittee). I believe the market needs to be overseen."

Nationally, Keamy, who is an anesthesiologist, said the federal government is requiring that his anesthesia codes match those of the doctor doing surgery in order for him to be paid for Medicare patients.

"Virtually every doctor's office has had similar experiences," Keamy said. "They kick back the claims as being incomplete, even though they know I did the anesthesia."

Last month, at the urging of President Clinton, the federal government ordered that Medicare payments be slowed and fewer written notices sent to beneficiaries. Insurance companies also are being urged to use voice mail to answer doctors' questions regarding non-payment of claims.

"Slowing the payment of money does not save money," Waid said, adding that he hopes insurers don't follow Clinton's example. "I think they (insurers) legitimately try to pay on time, but when they don't, they don't realize the effect is dramatic."

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