Doctors Without Payments After Insurance Backlog

Tuesday, February 24th 2009, 10:57 pm
By: News 9

By Rusty Surette, NEWS 9

OKLAHOMA CITY -- Doctors and dentists across the state are stuck with patients' bills. Some say it's forcing them to cut back on services and in some cases, their patients.

Those medical providers said an insurance backlog is to blame and if something doesn't change, patients could all be paying for it.

"In terms of dollar amount, we're probably out of $24,000," Dr. Robert Bauuman said.

Dr. Robert Bauuman is scraping around for extra cash lately because the group responsible for paying the insurance premiums for nearly 200,000 state employees, teachers and their dependents is severely backlogged and claims aren't being processed.

That's why some medical providers, like Dr. Bauuman, are beginning to struggle.

"It starts to add up," Dr. Bauuman said. "It affects your ability to pay vendors, to pay staff and it affects your ability to invest in your practice."

One out of every 10 patients Dr. Bauuman sees uses HealthChoice, the insurance plan used by most state employees and teachers. HealthChoice said its new claims processer, EDS, wasn't ready to take on the task on January 1. A problem with EDS's computer system started the backlog. A spokesperson for HealthChoice said they were warned in advance that there could be problems.

"In fairness to them, they indicated that they would like to have 18-24 months, but that is just not feasible financially or practically," HealthChoice Administrator Bill Crain said. "We gave them 12 months and they agreed to that."

Crain said there are 300,000 claims backlogged and millions of dollars now owed to Oklahoma doctors and dentists.

"We're seeing quite a few practitioners no longer being a preferred provider and turning patients away," Dr. Bauuman said.

Dr. Bauuman said for now, he'll continue seeing his patients who use HealthChoice, but if those payments don't start coming in, the cost of service could go up for all patients.

HealthChoice said it could be several months before they are caught up with the number of claims backlogged. Until then, they're urging patients and providers to be patient while they continue to work out the kinks in the new system.

HealthChoice is managed by the Oklahoma State Education and Employees Group Insurance Board.

Some lawmakers are now questioning why the agency is using EDS, a third party company, to process insurance claims.

Representative McCullough said he'd like to get together with other lawmakers and take a more in-depth look into the board's operations before making an official recommendation on what to do with it.