Insurance and Insurance Benefits and Letters and Opinion and Insurance Claims and Anthem and Health Care & Life Sciences and Health Care & Insurance

Let's set record straight on benefits

March 2, 2009
Rebuttal to assignment-of-benefits article [in the Feb. 2 Health Care Focus]: The insurance industry and [Indiana] Chamber of Commerce are providing misleading and untruthful statements to employers and their insured members about assignment of benefits.

Your article failed to mention the extreme burden placed on patients receiving the explanation of benefits that accompanies the check. A patient, untrained in insurance matters, has no idea of proper claims payment. How does an individual patient follow up on a low payment or nonpayment (denial) according to his/her contract with the insurance company?

How can a patient know if the insurance company was correct to deny payment for “not medically necessary” services, when in fact the doctor can prove the services were medically necessary. How can a patient know what are “reasonable and customary” fees? What about a Medicare crossover to a secondary insurance in a timely fashion to avoid non-payment for time-filing limits?

With AOB, the doctor’s trained staff will handle these issues.

Without AOB, the patient is on their own.

Insurers and their allies claim health care costs would spiral out of control with AOB — false.

Fact: AOB only allows the patient to direct where the payment and explanation of benefits are to be sent. There is no mention in the bill of how much the patient or insurance company must pay. The patient also can always choose whether or not to go to an out-of-network doctor.

Fact: Insurance companies pay out-of-network services at the same rate as in-network services.

AOB does not increase balance billing to patients. The patient can choose to go out of network and to be responsible for balance billing, or the patient can choose an in-network doctor to avoid balance billing.

Fact: Anthem can still “wring out” whatever they want to from in-network providers. AOB would not change this.

Mike Ripley of the Chamber of Commerce implies that AOB would harm the networks. There is no evidence of this in states with AOB laws.

Fact: Other insurance companies honoring AOB for out-of-network providers show no evidence that this harms their networks.

Fact: Of the 22 states that have assignment-of-benefits laws, more than half have lower insurance premiums when compared to Indiana. AOB laws do not increase insurance premiums to employers and employees.

We need to recognize the truth and pass AOB to honor the patient’s request to simply send the check to the provider.

___

Anthony C. Wolf
President, Indiana State Chiropractic Association
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