Medical Practices Pay the Price When Insurers Hold Reimbursements

Over the past two months, I have been monitoring specific insurance companies to watch and see how they are going to react with all of the changes coming this year due to the Affordable Care Act. Some payers will be absorbed, while others will go out of business completely. But those who have no plans to disappear are strategically placing themselves in the market, by making some pretty shrewd moves.

I first noticed HealthNet's A/R was over in the 30 day-to-60 day category back in late November, which means that there was some sort of activity going on at the end of October. Sure enough, I did some research and found that their stock dropped drastically at the end of October, and that their overall stock price had dropped 25 percent this past year.

What does this mean for your A/R? This means that HealthNet went from paying on average of 14 days to 17 days, to an average of 60 days! If you are a watchdog of your A/R, you know how drastic this is. Snooping a little further, I found that HealthNet was holding on to your money, so that they could pay their investors with the interest they made. They certainly do not want their investors to pull out now. Not only that, the CEO has recently made a big decision to not sign back on with a major hospital chain in California. This is also helping their stock price rise again.

As for the other big insurance company, Blue Cross is also making moves and waves within the industry. These changes will most definitely not just affect your A/R, but your patient population, as well. Back on December 24, 2012, WellPoint, who manages most all Blue Cross and Blue Cross/Blue Shield plans, acquired a company called Amerigroup Corporation, described by WellPoint as "one of the nation's leading managed care companies that is focused on meeting the health care needs of financially vulnerable Americans." So, not only does WellPoint now manage a majority of the insurance plans through Blue Cross and Blue Cross/Blue Shield, they now dominate the MediCad population, bringing their “total medical enrollment to 36 million customers.” This also brings their total enrollment to 66 million with the subsidiary plans.

When this happened, and most of you know that on January 1, many plans start over as a calendar year plan, several of your patients who have Blue Cross or Blue Cross/Blue Shield, premiums, deductibles, and co-pays increased. What also happened with this purchase of Amerigroup, is that Blue Cross held on to your reimbursements until they could recover from the $4.9 billion dollar purchase.

When big companies like this make such big moves and hold on to what is rightfully yours, there is not much you can do, but to educate yourself and be patient. The website that I have shared the links with in this article - Seeking Alpha - is a great source of information that can help you make solid business decisions.

As always, check your contracts with these insurance companies, because if they hold on to your reimbursements longer than what is stated in your contract, they are required to pay you interest!