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PPG- Alert to Clinical Social Workers re: Insurance Payment
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Alert to Clinical Social Workers re: Insurance Payment
(Spring 2007)

Some Members have been receiving notifications from insurance companies (or their representatives) urging them to agree to accept a reduced fee in exchange for timely payment of the insurance claim. This letter is being sent to out of network providers.
The letter gives the impression that the clinician's signature is required in order to release payment. For example, one letter shared with NASW-NYC states at the top: "Claim Must Be Processed ASAP; Please Sign and Return…" Out of network providers should be able to be reimbursed in a timely manner regardless of whether they reduce their fee or not.

Members have shared with us that they believe that if your client is receiving the reimbursement, your agreement to a reduced fee may reduce the client's insurance reimbursement, as well as the amount that you can collect from your client.

The experience that social workers are having suggests that insurance companies may be adding providers to their panels once they have signed the form for a reduced fee, thus affecting reimbursement for all clients covered by that insurance. If that is the case, it would seem to be a back-door agreement to becoming an in-network provider.

One member has recommended that providers consider contacting the insurance company representative whose name and number is on the letter and ask them to notate their records to indicate that the offer for educed fees is declined, both for now and in the future, for all clients. Short of this, they may continue to send the same letter every time a new claim is filed, further delaying the payment of each claim.

Some social workers have found that once this call is made, the claims have then been processed in the usual time frame (i.e., a few weeks). If the insurance company does delay payment, one may consider contacting the Office of NY State Attorney General Eliot Spitzer's Health Care Bureau Helpline at 800-771-7755 to file a complaint against the insurance company.

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