In an hour and a half meeting May 7 with Indiana Insurance Commissioner James Atterholt, the ISMA detailed physician members’ concerns about Anthem’s continuing claims processing and payment delays.

Armed with a 105-page agenda and summary – including examples of members’ still unresolved claims – the ISMA asked the Indiana Department of Insurance to assist physicians and their patients caught in the quagmire of Anthem’s computer glitch that began in October 2007.

The summary included numerous examples of Anthem’s unresponsiveness to physician office inquiries about claims and outlined the types of problems experienced, including claims processing, claims payment and customer service issues.

David Welsh, M.D., ISMA president, and key ISMA staff outlined a list of concerns: the untimely fix, miscommunication or lack of communication with physicians about unresolved claims, and late payments without interest as required by the state’s prompt pay law.

That opened the door to a discussion of the IDOI’s newly announced complaint form that limits complaints to a minimum of $250, which has left primary care physicians with no recourse.

ISMA urges removal of $250 complaint limit
“By putting a limit on the complaint, what you’ve said is provider complaints are not welcome,” Julie Reed, ISMA legal counsel, told the commissioner. The ISMA asked for no dollar limit on complaints.

“If the IDOI would allow physicians to file a cumulative amount instead of a single form for every individual issue, they would not be penalized,” said Dr. Welsh. The commissioner asked his staff to work with the ISMA to improve the situation.

Suggestions for a resolution
In addition, the commissioner asked for suggestions about what the IDOI could do. Here’s how the ISMA responded:

• Provide Anthem a deadline for getting all remaining claims processed and properly paid
• Ensure that health insurance carriers are complying with the prompt pay law
• Push Anthem to do provider education
• Investigate the problem and speak publicly about concerns and actions

The ISMA is preparing a letter to the IDOI summarizing the meeting and giving suggestions about possible actions. Watch ISMA Reports for further developments.