We have identified and taken advantage of significant opportunities to reduce current and future medical expenses by more closely challenging the contractual and medical appropriateness of claims received. The tug of war over payments is another front in the conflict between health care providers and cost-cutting insurance plans. Previously, the two groups have clashed over issues such as health insurers' efforts to shorten hospital stays, restrict access to medical specialists, limit patients' choices of doctors and hospitals, and require advance approval for tests and procedures. As formerly passive insurers become strict disciplinarians, much of the health care system finds itself tied in bureaucratic knots. Health care providers say payment denials and delays have intensified as health plans struggle to improve their profitability.
Hospitals say the unpaid bills make it harder to serve the public.
If in fact we can improve, we will. Both companies said they pay promptly except when they have reason to question a bill. Some of the loudest complaints have come from physician groups that staff Maryland emergency rooms. Maryland law prohibits HMOs from requiring prior authorization for treatment of emergencies. Now, some emergency doctors and firms that process their bills say the laws aren't working as intended.