Doctor shows why insurers exasperate him

Monday, Aug. 13, 2007 | 7:14 a.m.

Dr. Mehdi Ansarinia treats thousands of people for migraines, but his own headaches come from insurance companies.

He says he can't comprehend why insurance companies won't pay him what he is owed for taking care of their patients.

Nevada has a prompt payment law that requires insurance companies to pay or deny claims within 30 days. But Ansarinia, a neurologist with a solo practice, and other doctors interviewed by the Sun say delays have become common and the 30-day limit is not consistently enforced. Ansarinia agreed to open his books to show the Sun examples of the problems.

He says they show that about a third of claims are wrongly returned or rejected - often for seemingly ridiculous reasons - requiring more paper shuffling and return faxes and phone calls.

And many claims go unpaid. He said a multitude of companies owe him a combined $100,000 in unpaid claims, going back to 2005.

The companies return claims for absurd reasons, he said. As evidence, he offered:

Sierra had taken bills with the same ink tone before, he said, and other insurance companies accept bills with the same ink.

"Experimental services are not covered," the denial said.

"I don't know how they expect us to practice and see patients and do all this stuff," Ansarinia said of the bill chasing.

He says insurance companies use stalling techniques and wrongful denials to shortchange doctors and deny coverage to patients. The chronic problems are causing him and other doctors to think about leaving Las Vegas and hurting the quality of care for patients.

Officials from the insurance companies dispute the accusations of habitually poor payment. Peter O'Neill, spokesman for Sierra, said the company has a 5 percent denial rate, and it's often because doctors send bills to the wrong insurance provider.

Tyler Mason, spokesman for PacifiCare and its parent company, UnitedHealth Group, said United processes about 300 million claims a year. It paid 98.6 percent of them within 30 calendar days in 2006, Mason said. An even greater percentage, 99.5, were paid accurately, he said.

Cigna officials said they were recently ranked tops in a doctor survey of large insurance companies by the publication Physicians Practice Journal.

But other providers and billing managers say the insurance companies do create problems. Chris Lusiani, CEO of Red Rock Medical Billing, handles claims for 24 radiologists. He estimated that one in five claims gets delayed and perhaps half of those never get paid.

Most of the time, he said, he sends the claim electronically and receives confirmation of its receipt by the insurance company. When no payment comes within 45 or 60 days, Lusiani's team calls the insurance company, which usually says it never received the claim. Then Red Rock refiles the claim, Lusiani said, only to have the company reject it, saying it was not filed on time.

Is it maddening?

"Of course," Lusiani said. "But I've been in it so long and it's just the way it is."

Assemblyman Dr. Garn Mabey, an obstetrician, said nonpayment by insurance companies is a perennial problem, and it affects patient care. He said he makes patients pay up front to insert an intrauterine device, even though their insurance company may cover the birth control method. Too many times, he said, he has filed a claim and the insurance company says the patient is no longer covered. In some cases, he said, insurance companies will audit him after the fact and find a patient was not covered. Then they want him to re pay the money he received for the procedure, leaving him with the task of finding and collecting from the patient.

Health care attorney Maria Nutile said five doctors consulted her in recent weeks to discuss their frustrations with the insurance companies. Doctors are not allowed by law to bill patients for the unpaid amounts, so they end up losing money, and for some it's threatening their ability to operate, she said.

The Nevada Insurance Commissioner's office handles complaints about wrongly delayed or denied payments, but Nutile said she has complained a handful of times and never received a response. She said some physicians she has represented have sent as many as a dozen complaints with no reply.

"We've got a prompt pay statute in the state but it doesn't have any teeth in it," Nutile said.

In response to questions from the Sun, the insurance commissioner's office said Friday that it has received 450 complaints of delayed payments by carriers since January 2006. Those included complaints about health, mental health and dental insurance carriers.

Of those, very few resulted in findings of violation, said spokeswoman Peggy Dehl. She said the office cold not provide a specific number without conducting an extensive review.