Friday, August 09, 2013

NYS Early Intervention botches billing for commercial insurance too


Today we received notification that some of our early intervention families have been sent our payments for the services we provided to children.  The payments are not supposed to be directed to the families - they are supposed to be directed to the providers or to the State for processing.

Based on our private billing experience as an outpatient clinic, it is uncommon for insurance companies to send reimbursements directly to enrollees, but it happens.  Most of the time when the insurance company does this the family hands the checks directly to us.  Unfortunately, some people don't understand what the checks are or in some situations they just view it as a 'payday' from the insurance company and they keep the payments for themselves.  We eventually learn about this after we call the insurance company after a period of non-payment and they tell us that the claims were paid.  Then we are in the awkward position of calling the patient and asking them to pay the funds that the insurance company provided to them.

Thankfully our honest and forthright early intervention family called us immediately and told us about the 30 checks that they received for services we provided.  What will be fun now is to de-tangle the mess because some of the payments are for services my agency provided and others are for services provided by others.  Additionally, there will need to send the information back to the Interim State Fiscal Agent because the payments made were only partial payments.

We also reassured the family that the insurance company was incorrect and that the family is not responsible for co-pays and deductibles.

So, it seems that commercial insurance was the last of the payments that were not being processed, but now we see that even that part of the system is horribly broken.

Congratulations are in order to NYS Governor Andrew Cuomo and Bureau of Early Intervention Director Brad Hutton.  They have destroyed the billing and payment system for this important program from stem to stern.

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