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August 26, 2001 at 08:00 PM
Agents Caught In Middle On Texas Health Plan Fines
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The Texas Department of Insurance recently imposed $9.25 million in fines and millions of dollars in restitution payments to punish managed care companies for violating a state law requiring prompt payment of health claims.
The department hit 17 plans controlled by seven parent companies.
Health insurance agents interviewed say they have mixed emotions about the fines: they agree that regulators should act if carriers really are failing to pay health claims promptly, but they would like to see regulators avoid depending on fines.
“The managed care environment is not exactly overflowing with cash reserves right now,” says Gary Looney, a health insurance broker at Catto & Catto, San Antonio.
Besides, agents say, most of the claims problems they handle turn out to be the result of an error by a patient or a doctors office.
“Many times, medical offices send a claim just to get it out the door,” says Becky Parker, an agent at Nieman Hanks Puryear Benefits L.L.C., Austin.
The real Texas payment conflict is not over delays on individual claims, but delays in payments to group practices and other organizations that manage claims for many doctors, Looney says.
