From time to time, insurance companies understandably refuse payment on claims for a number of reasons. Elective services, out of network providers, and multiple other exclusions are legitimate reasons for an insurance company to not pay their beneficiaries’ claims. Right now however, no claims are being paid and the topic is so heated that extreme measures are being considered in order to take care of the problem.

Share Medical Center CFO, Denise Reed reports that HealthChoice, the state’s employee insurance carrier stopped paying in December on most claims to the tune of nearly $150,000, a figure that continues to grow. Medicare and Medicaid intermediaries, TrailBlazer and Palmetto have also been negligent in their payment practices ($122,000 for the hospital and $300,000 for hospice claims), further contributing to a major cash flow problem at SMC. Withheld payments such as these, account for nearly $675,000 of Share Medical Center’s current receivables.

In the past week, Share received $2,400 from HealthChoice and these are the first payments in months from one of the largest insurers in the state. While the payment is appreciated, it is a far cry from all that is owed to the medical center. Furthermore, there is no indication as to when the claims will be paid.

In a recent Fox 25 News report, the news team indicated that across the state, HealthChoice owed approximately $125 million to physicians alone. According to the report, the company, which currently has over 300,000 claims backlogged, lost approximately $52.5 million in 2008 and its losses are not insured. HealthChoice did however tell the news channel that the company is solvent with $112 million in reserve funds.

Solvent or not, doctors and hospitals are struggling to deal with this significant blow to their cash flow. Furthermore, there is serious concern whether HealthChoice will ultimately pay these claims at all. Discussions in meeting rooms across the state are focused on what to do about the problem.

Some providers are considering dropping their contracts with HealthChoice, which would mean state workers, i.e. teachers, highway workers, state prison employees, etc., would be forced to search for care where their insurance is accepted. This possible action is essentially in response to the breach of contract between the insurance company and the provider.

Others are considering making state employees pay up front for all services and having them file their own claims with HealthChoice. This action however, would likely only transfer the financial headache and burden to the patients. Most providers would prefer to bear the burden for their patients… within reason.

Share is urging all state employees with the state’s insurance plan to get on the phone with their state lawmakers and department heads, to demand that their covered services be paid for promptly. Consider a state worker who hadn’t paid their premium for the same period of time? Their insurance coverage would be dropped.

If things don’t improve drastically with HealthChoice, state workers across Oklahoma will essentially find themselves in the same boat as the uninsured. The difference being that the uninsured are not paying hundreds of dollars for insurance premiums each month.

Medicare and Medicaid are a different beast altogether. Given that these are government programs at both the federal and state levels, providers’ only action is to continue attempting communication. Elected officials have not been able to produce any results at this point and the waiting game continues. All the while, the hole keeps getting deeper.

From time to time, any one of these insurers or some other insurance company may be delinquent on their payments. Reed further stated, “I can never remember when we’ve had so much trouble with so many insurers, all at the same time.” All claims and coverage information is well documented, so all parties are likely to get their fair share… if they can weather the storm.