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"Happy" Thanksgiving - Feel The Pinch

November 25, 2008 / 0 Comments / in insurance / by Chip Hart

Recently, Susanne Madden predicted that the payers were going to start making “administrative” changes in the face of the economic downturn.  Well, if these two examples from the last 24 hours are any indication, we’re in for a rough ride.

  • First, BCBS of NC and LA (and perhaps many more) institute a little change.  You now have to pay for any appeals you make to the insurance company. That’s right: you appeal, you pay.  Sure, the “Tier 1″ initial complaints are “still free” but if the insco doesn’t respond in 30 days, it’s automatically thrown into Tier 2, where you have to pay.  At least $50 + a chunk of the claim.  Really.  You can read about it here, on PedTalk.  [Sorry the formatting is goofy!]  You may see the language straight on the NC BCBS site here.
  • Oxford/United (which sounds like a soccer team) just dropped, flung out, discarded, and now ignores all 92588s, the evoked auditory test.  No, it’s not like they aren’t paying for imms admin, but it’s still something.  By my rough estimation, using PCC’s data on the present usage of this code, that’s somewhere in the neighborhood of $2-3 million dollars they just dropped from their expected payout next year.  You watch: the whittling begins now.  And, if you were a subscriber to the Verden Group’s Alert service, you should know both of these things the moment they happen…unfortunately, most of your peers won’t learn until it’s too late to do much about it.  Thanks to Susanne for the head’s up.

Is it any surprise that these announcements come on one of the busiest weeks/Mondays of the year?

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