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Payment backlogs hit medics: Technical failures in a state insurance plan tie up millions of dollars.(Tulsa World (OK) Via Acquire Media NewsEdge) Mar. 31--Some Oklahoma doctors and dentists are struggling to stay afloat amid a backlog of unpaid claims from HealthChoice, one of the state's employee health insurance plans. Many have even taken out large personal loans to keep their practices operating, say the directors of the state's medical and dental associations. State Rep. Lewis Moore, R-Arcadia, said that doesn't even take into account hospitals throughout the state that are "feeling cash-flow restrictions to the tune of millions of dollars." "I've been investigating this for two months. There is enough blame for everybody," he said. All four Tulsa hospitals have experienced a backlog of payments, officials report. The backlog began after HealthChoice hired Electronic Data Systems of Plano, Texas, in November to process the plan's health insurance claims. The new payment system was supposed to start Jan. 1, but it didn't go into operation until Jan. 30. Even then, it didn't work well. "There's just all kinds of strange things happening. One dentist submitted claims and found that any patient with a hyphenated name got thrown out," said Dana Davis, the executive director of the Oklahoma Dental Association. She recently put out a call to dentists, asking for feedback on problems they are experiencing because of the backlog. In one day, 132 members responded, representing 5,000 unpaid claims and $2.9 million in unpaid reimbursements. "Most have been waiting four or five months for reimbursement," Davis said. Kenneth King, the executive director of the Oklahoma State Medical Association, said many of the state's physicians who accept HealthChoice are in the same situation. "One physician is owed $3,000, and he had to take out a loan to keep the doors open," he said. Most of the unpaid claims date back to 2008. King said that the largest amount that he knows is owed is $100,000. "Patients are also getting angry. Some of them are getting turned away by doctors because they have HealthChoice," he said. Moore said many patients are being told they must pay cash for their visit. HealthChoice has more than 200,000 members in the state. EDS, founded by Ross Perot, was acquired last year by Hewlett-Packard Co. for $14 billion, much to the chagrin of some Wall Street analysts who considered EDS to be an underperforming technology services company. EDS also is a contracted provider for the Oklahoma Health Care Authority, which administers the state's Medicaid program. Bill Crain, the administrator of the Oklahoma State and Education Employees Group Insurance Board, said that as of Monday, EDS had processed more than 500,000 claims totaling more than $83 million in payments. "We've made progress, but it hasn't gotten the backlog reduced appreciably to where it needs to be," he said. The unpaid claims could total up to $100 million, he said. The board and EDS are working to come up with a plan to get money out quickly to providers in most need, well before the backlog is cleared away, he said. "Regrettably, it's going to take some time, months rather than weeks," Crain said. "We're trying to get this back to some sense of normalcy." Oklahoma Insurance Commissioner Kim Holland is steamed. "EDS has not, in any way, shape or form, lived up to the promises they made," she said. "The fact is, they lied. This is an egregious breach of contract." The state has refused to pay EDS until the backlog is cleared up, Holland said. "They were not even remotely prepared for this, even though they made assurances they were," she said. Holland praised the insurance board for being firm with EDS and demanding that it increase its staff to adequately respond to calls and get claims paid. "We've been very forceful with them," she said. Holland wants to assure the public that HealthChoice remains financially viable. The situation developed because EDS wasn't prepared to make the technological transition, she said. "Our only consolation is that we're not paying them," she said. Moore said the company also faces penalties for delayed payments. State law requires a penalty of 10 percent interest on claims older than 45 days, he said. King said the medical association plans to meet with EDS on Thursday to air its concerns. "We are going to insist that our physicians' claims get immediate attention," he said. "I think they are making a good-faith effort. But it isn't enough." Kim Archer 581-8315 [email protected] To see more of the Tulsa World, or to subscribe to the newspaper, go to http://www.tulsaworld.com. Copyright (c) 2009, Tulsa World, Okla. Distributed by McClatchy-Tribune Information Services. For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA. |