Advocacy Alert: April 2014

Ask Us—OPA’s Insurance Company Contacts may be Able to Help You

Bobbie_CBy: Bobbie Celeste, PhD, OPA Director of Professional Affiars

Insurance Tips

Late Payments
The Prompt Pay law requires prompt payment of psychologists’ bills. If you are having difficulty collecting in an accurate or timely way, please let OPA know by contacting me.  The Ohio Department of Insurance accepts complaints from providers and patients. Here is a link to the information you need to file. The first step is to contact the insurance company. If you do not get a reply or an unsatisfactory reply, move right ahead and file a complaint with the Insurance Department and contact me at OPA. The sooner you speak up, the sooner this can be resolved.

Claim Denials
Are your patients being denied needed services? Again contact OPA as soon as possible. Several routes are available to you. Ohio has a little known External Review process that can be used to fight denied claims. Those with questions about appealing their insurer’s health coverage decisions can call the Insurance Department’s consumer hotline at 1-800-686-1526. Patients deserve the coverage that they are paying for and sometimes they are not receiving all the benefits that the company advertised they would receive. Please contact me for assistance.

Decreased Payment for Denied Claims
Insurers will sometimes convince the provider to take a reduced fee for claims that were originally denied. If you agree to accept the lower fee, the claim is not considered denied and you no longer have any way to appeal or ask for an external review.

Mental Health Parity
The rules regarding state and federal mental health parity are complicated and confusing. If you think your patient is not receiving parity in their mental health benefits, first find out these facts about their insurance: Self-insured or not? Government entity or not? Size of company (50 or over?). Next, check out the state mental health parity tool kit at this link. For federal parity, please contact me.

New HCFA (02/12) Form
If you file paper forms, don’t forget that you need to use the new HCFA (02/12) starting today, April 1, 2014. Packages of 500 are available from Amazon and other medical forms sellers for about $20.
Instructions for filling out the new form are available free at this link.

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