Measure to mediate billing battles between managed care firms and doctors moves forward

02/21/2013 12:25 PM

As doctors and hospitals continue to struggle with getting paid for caring for Medicaid patients, House Speaker Greg Stumbo said Thursday a better mediation process spearheaded by the Department of Insurance could help ease the conflicts.

“I personally believe if a system like this is put in place, many of the complaints will go away,” Stumbo told the House Health and Welfare Committee as he presented his bill, House Bill 5. It passed the panel unanimously.

Kentucky hospitals, doctors, mental health agencies and dentists continue to complain that the three managed care companies the state hired in Nov. 2011 are delaying payments for medical services they provide to Medicaid patients — or are denying claims. Managed care companies say they have smoothed out the process and most remaining problems are with the providers’ billing services. And Health and Family Services Cabinet officials say they’re helping to negotiate the disputes.

“It’s difficult to understand who really is correct in what they say,” Stumbo said.

He pointed out that the state had paid managed care companies $1.3 billion but just $800 million of that had been sent to providers to cover the care of Medicaid patients.

Stumbo’s measure gives the state Department of Insurance the power to step in and mediate disputes and make sure the payments are being made promptly.

He said while the Health Cabinet officials might have “some reservations,” he spoke to Gov. Steve Beshear on Wednesday night about it.

“He seemed OK with it,” Stumbo said.

The latest version of the bill gives the Department of Insurance 60 days to put staff in place to handle the disputes. And legislators — including Rep. Jimmie Lee, D-Elizabethtown, the chairman of the House budget subcommittee on health — said the measure won’t affect the contracts the managed care companies signed with the state in 2011.


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