Insurance Companies Fail To Inform Physicians Of Right To Appeal
All too often a physician treats a hospitalized patient and is then informed by the insurance company that the in-patient services, provided both by the hospital and physician, are not covered. The physician accepts the insurance company’s representation and believes the matter is closed. Far from it! What the physician does not know is that the hospital appeals the denial of payment and is successful in receiving most, if not all, of the reimbursement from the insurance company. At no time did the insurance company ever inform the doctor of the hospital’s appeal. As a result, the physician either never finds out that the hospital has been reimbursed or does learn about it, tries to appeal, but is told that the appeal is now untimely. As a result, doctors who fully deserved to be paid for the services they rendered are not compensated at all.
We believe the insurance companies have a duty to inform the physicians if the hospitals appeal under these circumstances so that the physicians can also submit a timely appeal and be appropriately compensated.
If you are a physician who provides in-hospital services, there is a good chance that you were/are a victim of this scheme. If you have any questions or comments about this, please contact us.