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CHICAGO, IL (AP) — The nation’s largest doctors’ group says about one in five payments of medical claims by commercial health insurers is inaccurate, shortchanging physicians.

The American Medical Association released its annual report card on insurers Monday. The AMA says eliminating mistakes would save doctors and insurers $17 billion a year.

The AMA rated UnitedHealthcare highest of seven commercial insurers with an accuracy rate of 90 percent.

Medicare, the government program for people 65 and older, was even better, with a 96 percent accuracy rate.

Lowest rated was Anthem Blue Cross with 61 percent. Anthem’s parent company, WellPoint Inc., responded that it is increasing electronic claims processing while decreasing paper billing and now receives about nine of 10 claims electronically.

The AMA is holding its annual meeting in Chicago.

Online: http://www.ama-assn.org/go/reportcard

(Copyright 2011 by The Associated Press. All Rights Reserved.)

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4 Comments on "AMA: Doctors shortchanged by insurers’ mistakes"

David Jewel
2015 years 9 months ago

Cause they do the same to their insured as well. I’ve been waiting months to get back surgery I need after a fall at home in January. BCBSNC answer so far has been take narcotic pain meds and PT which my Neurosurgeon made clear to them wasnt an option I have a grade 4 at minimum tear in the disc between two vertebrae and Deg disc issues it isn’t going to magically heal on it’s own and even a partial healing would only leave me susceptible to further injury if not surgically repaired. I’m not some old fart I’m 37 yrs old and want to be a productive member of society again but for some reason BCBSNC thinks its ok for me to pop pills and be in pain and useless and collect crappy disability checks instead of a regular pay check as long as they get their money they dont care about you or paying claims no matter what they say and their commercials on TV acting like they care about their “members” are nothing but false advertising as far as I’m concerned. If anybody from BCBSNC cares to respond be my guest you have my contact info in Raleigh I’m sure on my account.

2015 years 9 months ago

Now reported.. Doctor’s shortchange patients as insurer’s shortchange doctors!

By the way.. If I pay cash at a Doctor’s office (self pay) why can I not get the same discount as an insurance company? I mean.. I wouldn’t try to short change them.,. I just want affordable med care I can pay for out of my own pocket…

Example –
Annual visit – Selfpay $150
A major insurer pays $60 to the Doctor for the same visit…

How is that fair???


ilm reader
2015 years 9 months ago

I find it hard to believe that physicians are monetarily shortchanged. In my opinion, they are double billing and being reimbursed for this. I went to Wilmington Health for an annual physical. A week later when I received my statement from BCBSNC, I noticed that I had been billed twice for the same appointment, and charged a handling fee for blood work that was ordered. After calling BCBSNC, I was told that during my 10 minute “annual physical,” I must have discussed something non-preventative, because the physical appointment pays for only “preventative measures.” So, the physician was billing an additional appointment at $200 for their “educational and professional knowledge.” I discussed 4 things with my MD….in 10 minutes. In addition to being billed for the extra lab work, the MD billed an additional $25 for????—I’m not sure what,- a “handling fee.” So, I now have to pay an additional out-of-pocket of about $140. And BCBSNC doesn’t blink an eye and reimburses the physicians this double billing. And we wonder why our health costs are so high? The next time I see my physician, when she asks, “so how is this or that?”, my response will be,” I can’t answer that; you get to bill me another $200 if I answer.”
I am absolutely outraged. I can’t believe that this is acceptable. If I had a plan that required a co-pay would I have had to pay 2 co-pays for 2 visits when I left the office? I think not! And that is why most of us would not notice this billing practice, unless you have a policy like I do: $5000 out of pocket for BCBSNC negotiated rate and then they cover at 100%. Shortchanged? No! Double billing and getting away with it! Something needs to be done!

2015 years 9 months ago

do something.

File a complaint with the Department of Insurance.


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