Medical claims process faces review

Thursday, Sept. 25, 1997 | 11:22 a.m.

The Committee on Benefits will negotiate with its consultant, William Mercer Inc. of Los Angeles, to review UICI Administrators, hired in August to process medical claims for the state employee insurance fund.

"We as a committee need some independent verification that UICI does appear to be set up properly," panel member and state Budget Director Perry Comeaux said Wednesday.

Jan Marie Reed, director of claims operations for UICI in Nevada, said the review would be welcomed.

The committee wants to ensure that the state employee insurance fund is protected from potential theft. The committee learned recently that the fund lost more than $600,000 during its administration by L&H Administrators.

State officials are pursuing an insurance policy taken out by L&H to recover any losses resulting from possible fraud. The FBI is investigating the missing funds.

The committee also told a doctor who complained about the lack of payment to his firm to give the new administrator a chance to catch up with a backlog of 105,000 claims.

Dr. Roger Meyer of the Carson Medical Group said he knew of doctors who are close to insolvency because state medical claims haven't been processed for the past three months.

Meyer told the committee his business is owed about $200,000, although some claims recently had been processed for the business by the new administrator. The physician said he instituted a requirement that patients pay for services up front but subsequently discontinued the practice.

Committee Chairwoman Jeanne Adams of Las Vegas agreed that the failure of L&H to pay claims, which resulted in their termination in late May, is causing problems for everyone.

Reed said her firm is committed to making the claims current by the end of the year, and Comeaux said the best course of action would be to let the company do its work uninterrupted.