Some health care providers are struggling to have claims processed and paid by Blue Cross Blue Shield of Wyoming so far in 2019. The insurance company attributed the slowdown in claims processing, particularly in physical and speech therapies, to kinks in a new operating system and platform.
“We’ve been working late nights and overtime to correct those little glitches that pop up that you didn’t expect,” said Wendy Curran, vice president of care delivery and provider affairs. “I know there were a couple areas, PT being one of them, where we just had a very difficult time getting it to work correctly. We’re working through it and we’re very optimistic that we will have a better level of service with a lot more digital. It’s just a matter of getting there.”
Some clinics in Teton County are nearing 3 1/2 months without a normal flow of payments.
“It’s making it challenging to cover large expenses, including payroll and rent,” said Maria Lofgren, co-owner of Excel Physical Therapy. “We’re relying on all of our other insurance payments that we get to just keep us afloat.”
Peak Physical Therapy is facing similar challenges.
“We basically haven’t been reimbursed by Blue Cross yet significantly for the year,” owner Hayden Hilke said. “Right now it just feels like we’re working for free. It is definitely putting a strain.”
Four Pines Physical Therapy and St. John’s Medical Center have also seen claims processing slow.
Jill Spears, who does billing for several medical practices in Teton County including Excel, says wait times are dragging on. Previously, electronic claims were processed within a week or ten days. Now, she said it’s typical to see 60 days — even if the claim is going to a patient’s deductible and won’t be paid by the insurance company.
“There are people still waiting for authorization for services performed in 2018 and no one’s even calling them back,” Spears said of providers. “They see these people, they treat these people, but the claims are still sitting out there. Whether or not they’re going to get paid or processed, nobody knows.”
Claims should have already been paid or will be paid soon, Curran said. In an email, she wrote that “although we have some programming issues on our new system, claims for fully-insured individuals and groups that had been held up for accuracy testing are now being paid. Self-funded groups tend to have more unique benefit requirements, so we’re now testing to make sure those items have met the programing changes needed for self-funded groups.”
Small-business owners say they depend on Blue Cross Blue Shield, the only insurer on the Affordable Care Act exchange in Wyoming.
“When we haven’t been paid by our biggest paying source, we really struggle as a small clinic,” Hilke said.
Just under one-third of St. John’s Medical Center patients are Blue Cross Blue Shield, Chief Financial and Chief Operating Officer John Kren said.
“We’ve definitely seen a slowdown in the rehab space for sure,” he said. “They are paying our claims, we are getting paid over time — we haven’t seen any big uptick in denial issues or claims not being paid or anything like that. It’s just taking more time.”
Director of Revenue Cycle James Hohl said he wasn’t concerned.
“Our comfort level is high because of our communication,” he said. “We’ve got a great relationship with Blue Cross Blue Shield.”
We’re on the phone with them daily, they’re a big part of St. John’s.”
Providers said Blue Cross Blue Shield is usually the best insurer to work with.
“In the past, they were the most dependable insurance carrier I had,” Lofgren said. “It’s hard now that that’s changed. I’m hoping this is a temporary thing and we get back on track.”
Meanwhile, billing office managers like Jill Spears are spending extra time trying to make sure their clinics, like Excel, are paid.
“That’s one of those administrative burdens that medical practices don’t need on top of all the burdens they already have,” Spears said. “That type of thing can just make a business office snowball and make a practice go down. I’ve seen that happen before.”