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| Vol. 24, No. 17 |
| September 15, 2002 |
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"Hassle Factor Log" Helps Physicians Collect Insurance Reimbursements
Despite paying $50 million in fines and restitution, health insurance plans operating in Texas continue to delay payments to physicians, reports the fourth annual Hassle Factor Log compiled by the Texas Medical Association. Doctors sent a record number of complaints to the Hassle Factor Log, TMA's program for collecting and documenting member complaints about health care plans. The information is used to resolve individual problems, effect systemic change with health plans and state agencies, and set the statewide medical association's legislative goals. Approximately 1,500 physicians submitted more than 12,000 complaints last year, up 8.5 percent over 2000, reflecting the many ways plans increase medical care overhead costs. Doctors cited slow processing, data entry errors, improper denials and appeals, extensive requests for medical records, combining the fee for two or more services into one, and near-terminal on-hold time. "Far too often, health plans are sitting on the money patients and their employers pay for health care," said TMA President Fred Merian, MD. "The plans are using that money to their benefit while driving up the cost of care for everyone." TMA uses complaint statistics to work with health plans to improve the process for both parties. TMA staff goes to bat for doctors on those complaints for which reasonable attempts to collect, including the appeals process, have been unsuccessful. "We have convinced some of the carriers to change a few of their more onerous judgments, such as arbitrarily paying for only one procedure for a patient when the doctor has provided two or more at the same time," said Teresa Devine, director of health care financing for TMA. "For example, during major abdominal surgery, a doctor may order a liver biopsy. As a result of meetings with TMA, at least one plan has acknowledged that these are two separate procedures requiring different skills, different personnel, different equipment, and now are paying for both. "We don't contest all 'bundling' or combinations," she said. "There are instances when it is clinically appropriate to combine two procedures into one billing code. We approach this issue with common sense and clinical reality." Managed care plans still lead the herd in number of complaints over the four years the log has been maintained: 64 percent for managed care versus 15 percent for commercial insurance. Medicaid and workers' compensation account for 3 percent each. TMA is the largest state medical society in the nation, representing more than 37,000 physician and medical student members. It is located in Austin and has 119 component county medical societies around the state. TMA's key objective is to improve the health of all Texans. - Texas Medical Association
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