Health providers, insurers fight over patients' check



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After someone has an auto accident and receives a payment from his or her insurer to pay medical bills not covered by health insurance, who should get the check, the patient or the doctor?Currently, the check goes to the patient, who sometimes pockets it, leaving the doctor or hospital without a payment."With high deductibles, this has become a big problem for our members," said Paula Minnehan, a lobbyist with the New Hampshire Hospital Association.Senate Bill 336 is supposed to be a solution. The bill would allow "health care providers to bill for and receive direct reimbursement for their service," but the industry and some senators fear the language is so broad it would mandate that health insurers pay providers, even those with which they have no contract.That's why Paula Rogers, a lobbyist for Anthem Blue Cross Blue Shield of New Hampshire, was there. Anthem pays providers directly, but usually only those with which it has a contract. Those contracts are a way to leverage lower costs, she said.If the insurer had to send a check to all providers, there would be less of an incentive for providers to negotiate. Such an issue came up last year when ambulance services asked that they be reimbursed directly, not the patient.But, said Scott Colby, vice president of the New Hampshire Medical Society, "when an auto insurer sends a check for medical expenses, it was never intended to be a windfall for the patient."Once upon a time, providers could simply have the patient designate at the time of service that the check be sent to the provider. But that law was changed because, as average payouts increased from $1,000 to $5,000, the Legislature felt it should be up to the patient whether to spend that money toward a deductible or physical therapy.And when multiple providers are involved, why should the government decide who gets paid first, or at all?Or, as Sen. Matthew Houde, D-Plainfield, put it: "What do you do when you have a race to get paid?"The bill's sponsor, Sen. Tom DeBlois, R-Manchester, agreed that the bill measure needed to be reworked and said he would talk to both the auto and health insurance industries to figure out how to do it. -- BOB SANDERS/NEW HAMPSHIRE BUSINESS REVIEW Edit ModuleShow Tags