Third-party companies trying to reduce your refund

One of my vendors received a phone call today from a man who introduced himself as someone who wanted to give him a check for services he had provided to a patient, but just needed to fax him a piece of paper to sign. She got the paper and didn’t understand what it was so she faxed it to me, Thank GOD!

I’ve been looking at this for the last year or so. A third party company comes in and receives claims from an insurance company. They then contact the medical provider and try to get them to sign an agreement which basically states that if they agree to a reduced rate, they will be reimbursed faster! What nonsense!

First of all, it doesn’t seem legal that these third-party companies can get these claims from the insurance company. I think it breaks some kind of confidentiality. And second, an insurance company is supposed to process a claim within 45 days of receiving the claim. If the claim is only for fairly common services and all the information on the claim is accurate, the claim must be paid in a timely manner anyway. And furthermore, I found that by the time they contact the carrier and try to get them to sign the contract and then finally pay the claim, the same amount of time that it would normally take has passed for the claim to be processed by the original carrier.

Also, why should the provider take a pay cut? The last one I received was a 26% reduction of the approved amount. And the incentive is something that is supposed to happen anyway? Timely payment of services? It really doesn’t make any sense to me!

I always advise my suppliers to just say NO! Do not agree to reduce your rate. We call the original insurance company and ask why the claim is still not paid. And we call and/or fax the third-party company to let them know that the provider will NOT be participating in your game.

So if you’ve ever been contacted by one of these third-party companies asking you to agree to a reduced rate and you don’t feel like paying someone who has nothing to do with the service they provided, then tell them thank you but no. thank you! After all, you are already required to accept the rate that the insurance company deems reasonable for the service you are providing. Why should you take another pay cut?

When we submit claims electronically, most claims are submitted electronically these days, over 90% paid within 2 weeks. That basically makes this offer a “take a cut in payment so we’ll pay you back in the same amount of time” offer. Doesn’t sound like a deal to me!