Finding a therapist who takes your insurance can be nearly impossible. Here’s why – NPR

If you’re a healthcare provider dealing with insurance companies, it’s important to be aware of several common issues that can affect your payments and operations:

1. Prompt Payment Laws: While many states have laws requiring insurers to pay providers quickly after a claim is filed, the enforcement of these laws varies. Delays in payment can disrupt your cash flow and business operations.

2. Insurance Clawbacks: Insurers can request the return of payments if they find billing errors, even years after the fact. Some states have limitations on how far back an insurer can claw back money, but about 10 states have no such restrictions.

3. Billing Errors: Providers may be audited for even small mistakes in billing, which can lead to a complete halt in payments. This was the case with Anna DiNoto’s practice, where a prepayment audit over minor documentation issues resulted in significant financial strain.

4. Provider Exit from Networks: Faced with delayed payments or clawbacks, providers may choose to leave insurance networks. This can disrupt care for patients who rely on those providers and may struggle to find new ones within network.

5. Impact on Patients: When providers exit networks due to payment issues, patients can suffer. They may experience disruptions in care, have difficulty finding new providers, or face higher out-of-pocket costs.

6. Communication with Insurers: It’s crucial to maintain clear communication with insurers during any audit or dispute over payments. Being proactive and seeking resolution can sometimes prevent more severe actions by the insurer.

7. Documentation: Maintain thorough and detailed documentation for all services provided, as this can help in case of an audit or payment dispute. This was a challenge for Anna DiNoto’s practice, which faced scrutiny over the level of detail in their notes.

8. Advocacy and Support: Seek support from professional associations, legal counsel, or advocacy groups that can assist with navigating complex insurance issues and provide representation when necessary.

9. Preparation for Audits: Be prepared for audits by having systems in place to ensure compliance with billing rules and documentation standards. This can help minimize disruptions if an audit occurs.

10. Legislative Action: Consider advocating for stronger legislation at the state level to protect providers from unfair practices by insurers, such as excessive delays in payment or unreasonable clawbacks.

Remember, while this is a complex issue with many variables, staying informed and proactive can help mitigate some of the challenges you may face when working with insurance companies. It’s also important to keep an eye on legislative changes that could affect your rights and obligations as a healthcare provider.