Plans usually limit such updating to six or 12 months, according to the medical association. But state laws and regulations on retroactive denials will not affect self-insured companies, which are some of the worst offenders and are protected by the Employee Retirement Income Security Act of 1974, according to Teresa Devine, director of the health care financing department at the Texas Medical Assn. She added that one of the companies that is most intent on issuing retroactive denials is one of the largest employers in the country. Devine said the Texas Medical Assn. Officials at several medical societies said other states have also passed laws and more are considering them, but they could not identify states.
Doctors still have some options in states with no laws against retroactive denials.
Devine said that in Texas, at least, practices have the right under case law to refuse to repay such bills as long as repayment was not specified in the contract. But she added that physicians may be powerless if the plan simply subtracts the amount out of the next payment. Meanwhile, hospitals and large practices are beginning to remove provisions for retroactive denials from their contracts and to bar the practice in new contracts. Last August, after months of negotiation, San Francisco-based Catholic Healthcare West, one of the largest hospital networks in the nation, won a new contract with Blue Cross of California that erased the provision. Physicians have less luck amending their contracts unless they are in groups big enough to have some negotiating clout.