Oklahoma Medical Providers Say Insurer Payment Backlog Affects Work

April 16, 2009

Medical providers in Oklahoma say their office operations are being negatively affected by a backlog of more than 200,000 unpaid health and dental claims by an insurance plan for state employees.

The backlog of HealthChoice payments now totals $80 million to $100 million, forcing some providers to take drastic steps. One Oklahoma City medical group, Digestive Disease Specialists Inc., had to borrow money to meet payroll, while most of its 18 physicians went without a salary for two months, gastroenterologist Carl Raczkowski said.

At a medical center in Alva, the backlog reached $250,000, equaling the hospital’s operating costs for a month, said Denise Reed, the hospital’s chief financial officer. Reed said that since she informed state legislators about the issue, the backlog has been reduced to about $50,000.

“We have been receiving payments almost weekly since the first of March,” Reed said. “We’re still surrounded by other providers who are still struggling. It’s affecting physicians, drug stores, pharmacies.”

Bill Crain, the administrator of the Oklahoma State and Education Employees Group Insurance Board, which manages the HealthChoice plan, said the backlog resulted from technical issues caused when the plan changed companies that process the claims. He said slow progress is being made.

The new claims processor, EDS, has a $17 million contract with Health Choice. EDS processed about 100,000 claims last week, while HealthChoice receives about 50,000 claims per week.

“It’s going to be a process that’s going to take months,” Crain said.

Raczkowski said EDS is behind on its payments to his group by $400,000. He said EDS made matters worse by sending letters to his group’s patients, telling them they were not covered for medical procedures. Raczkowski said the mix-up happened because EDS did not recognize medical groups, just individual doctors.

“It all doesn’t make sense,” he said. “We’ve never had significant problems with HealthChoice before. At this point, I still can’t understand why we changed. … It seems like they (EDS) are learning on the job to me.”

Crain said HealthChoice decided to switch to EDS because officials liked the MetaVance claims processing system that is owned by EDS.

“That system has a very good reputation in the industry, and EDS has a good reputation,” he said.

Raczkowski said his group is not requiring HealthChoice policy holders to pay upfront for medical services.

“Our philosophy is to take care of patients,” he said. “The teachers and the state (retirees) and the state employees – they didn’t do anything to cause this.”

Information from: The Oklahoman, www.newsok.com

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