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April 2, 2002     (512) 463-0300

More Baby Steps Towards Prompt Payment of Health Care Providers

FORT WORTH - The Committee on Prompt Payment of Health Care Providers met Tuesday, April 2, 2002, to review recommendations to improve the payment of health insurance claims to providers by insurance companies.

The University of North Texas Health Science Center in Ft. Worth seemed a practical place to hold the hearing, and allowed over 50 public witnesses, mostly physicians and hospital representatives, from the metroplex area to come forward with testimony. One private citizen who testified was accompanied by her infant child.

The testimony also included a panel of expert witnesses, headlined by Texas Insurance Commissioner Jose Montemayor. Montemayor addressed the entire committee charge and spoke on the issue of medical malpractice claims, stating that several carriers have stopped writing malpractice claims. Only four carriers currently write malpractice claims, down drastically from 17 carriers last year.

Senator Mario Gallegos explained that the problem with so many malpractice claims coming from areas near the border is that there are no medical schools down there to teach specialties such as oncology, thoracic surgery, or neurology, leading to a shortage of specialists.

Statewide, about half of all physicians have faced malpractice claims since 1992 and insurance companies are not enthusiastic about paying claims of that percentage.

Dr. Bohn Allen of the Texas Medical Association and Tarrant County Medical Association followed, asking rhetorically "what is the definition of a clean claim?" That proved to be the question of the day as it was asked again several times by other witnesses and committee members. Allen then presented, in his opinion, four solutions to slow payment: a uniformed definition of a clean claim, a uniform code system, well defined penalties, and compatible software for computerized filing. In essence, these were the basic provisions of the vetoed House Bill 1862.

Ms. Jay Dhingra of the Texas Hospital Association echoed Allen's comments and added that approximately 25 percent of claims are paid inaccurately, and that the insurance companies can virtually decide what they wish to pay or not pay.

Insurance company representatives Janice Fagen of Unicare, and Dr. Bill Taylor of Aetna were also on the panel, both announcing a high percentage of timely payments. Fagen suggested devising a system of graduated penalties rather than bill charges, while Taylor stated that Aetna and other carriers do, in fact, pay claims, but only to limited codes of liability. He further cited doctors and hospitals for things such as doubling claims or abusing the claims codes, bordering on the accusation of fraud by health care providers.

In the midst of all the professionals, the most important message came in the silent testimony of the baby, emphasizing the fact that the patients are the ones who ultimately suffer if health care providers cannot afford to stay in business.

The Committee Chair is Senator Jane Nelson and members include Senators Mario Gallegos, Troy Fraser, John Carona, and Judith Zaffirini. The committee was joined by the chairman of the Health and Human Services Committee, Senator Mike Moncrief; new Senator Craig Estes; as well as Representatives Charles Geren, Bill Carter, Glenn Lewis, and Vicki Truitt. The committee recessed subject to call of the chair.

You can access the archived webcasts from the web page of the Committee on Prompt Payment of Health Care Providers.

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