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Health Coverage Carriers: More Than a Slap on the Wrist

By Maxine Shapiro, KERA 90.1 commentator

Dallas, TX – Are you bothered by your health care professional or hospital because they haven't received a penny of the bill that you rightfully thought your insurance company was paying - two months ago? You're not alone. I'm Maxine Shapiro with KERA Marketplace Middays.

According to the Dallas Morning News and a press release by the Texas Department of Insurance, another 13 health insurance carriers are being fined for "failing to pay physicians and healthcare providers within the time set by law." I say "another" because that makes it a total of 35 health insurance companies that have had to pay fines and restitutions in just the past 8 months.

This really struck a cord with me. See, last August I had to be hospitalized for a few days. I'm fine now, but I wasn't then. Two months later, I started receiving calls from the doctors and hospital and clinics that they haven't received any payment on the bill. I called my health insurance carrier. Three months later, I get calls threatening collection. I call my health insurance carrier. Finally in January and all the way into February, my health insurance carrier decides to pay the bills.

After reading yesterday's press release, I decide to call the Texas Department of Insurance. Jim Davis, director of public information, was kind enough to explain just what's been going on.

It was in 1997 that the state legislature passed the prompt-pay law requiring health insurance companies to pay bills within 45 days of receiving a clean claim. Davis told me that since then, doctors, hospitals and clinics have been justly filing complaints against the carriers that have not been paying on time. It was the onslaught of these complaints since August 2000 that forced the Department of Insurance to launch an investigation. This provoked administrative action in the form of fines totaling over $13 million. And so far, these carriers have paid $7 million in restitution to physicians and hospitals.

Though this action was appropriate and necessary, I have just one question. Do you honestly think that these fines and restitutions that the insurance carriers are paying are not going to be passed down to the consumer? I'm sure it will just be a matter of time. For KERA Marketplace Middays, I'm Maxine Shapiro.

Marketplace Midday Reports air on KERA 90.1 Monday - Friday at 1:04 P.M.