New complaints arise about insurance benefits

Friday, Jan. 30, 1998 | 9:05 a.m.

But medical providers say the method in which the claims are being paid is causing an accounting nightmare.

UICI of Texas was hired last summer by the state Committee on Benefits to pay medical insurance claims for more than 30,000 state workers and their dependents. L&H Administrators, the former contractor, fell behind and the committee fired the company.

UICI inherited a huge backlog of claims. Jan Marie Reed, an official of UICI of Texas, told the benefits committee Wednesday it has about 92,000 claims still not paid from last year.

But by using a double payment system the company is paying off doctors, hospitals and other medical providers for services provided in January.

Reed said 78,223 claims have been paid this month. And she maintains the backlog will disappear in mid-March.

But medical providers complain that the accounts of patients can't be reconciled.

The benefits committee authorized UICI in November to make advance payments to doctors, hospitals, medical labs and others to help them out of financial difficulty brought on by delays on the part of the state in paying bills.

For instance, Associated Pathology Labs was owed $1.3 million for bills up to Oct. 31. It received an advance payment of $800,000 and plans to settle for an additional $100,000. The total amount, however, is $400,000 less than the original bills

The advance payments were issued on request to eligible health professionals and companies.

But Diane Moore of Carson Medical Group, which includes 14 doctors, said it got one payment in November and hasn't received any money since. About 25 percent of the group's business is with state workers.

Moore also said the billing method makes it impossible to tell what individual's bill was being paid by UICI.

Cathy Wood of Carson Neurology testified her firm hasn't received any payments for services since August.

Benefits Committee Chairwoman Jeanne Adams of Las Vegas directed UICI to get together with the medical providers to work out the problems within the next two weeks. But she also defended UICI, saying no company in this nation could have handled the problems that were inherited from L&H Administrators.

"This is the biggest nightmare the state has ever had," Adams added.