Many physicians are often not paid in a timely manner for health care services rendered to patients. They and their staff must, therefore, spend an extraordinary amount of time and effort on reimbursement issues to the detriment of their appropriate focus, which is patient care. Insurance carriers and health plans unreasonably delay payments to physicians for many months, as well as arbitrarily reduce payments without proper cause. Orthopaedic offices report that accurate and valid claims may remain unpaid for more than 90 days. Many insurers also delay payment of larger claims by finding minor errors in ancillary portions of the claim. The AAOS supports prompt payment of uncontested claim by government agencies, insurance companies and managed care plans within a 30-day time period. The AAOS also supports the prompt payment of any part of a claim that is complete and undisputed. The AAOS believes insurance companies and managed care plans should notify physicians promptly if a claim is in dispute or the payer desires additional information.
Legislatively, states can create laws that require payment within a specified amount of time and may assess penalties against payors that are delinquent in their payments.