A lot of attention is focused on AMS successes during each legislative session, usually on big bills with big impact. What doesn’t always get the attention they deserve are AMS bills that try to address some of the smaller hassles of practicing medicine and running a practice.
A good example is Act 706 of 2019, the Healthcare Payor Identification Card Act. The new law was originally filed as Senate Bill (SB) 527 and was sponsored by Rep. Deborah Ferguson (West Memphis) and Sen. Cecile Bledsoe (Rogers). The legislation addresses a common dilemma faced by clinic staff when trying to file complaints against payors.
Here’s the scenario: AMS gets a call from a member clinic about a problem it’s having with a particular insurance plan. Let’s say that the clinic has a backlog of unpaid claims from this payor and has been trying unsuccessfully to get the issue resolved. Frustrated, the clinic staff calls AMS for assistance.
As part of our suggested course of action, we recommend that the clinic file a formal complaint with the Arkansas Insurance Department. First, we must determine if the health plan is regulated by the Department. We ask, “Is the plan an insured plan or a self-funded plan?” Frequently the answer is, “We don’t know, but it says United Health Care on the card.”
The reason the clinic doesn’t know is that the ID cards, while containing lots of “stuff,” usually don’t make this clear. You’ll see things like Trugreen PPO Network, BIC Insurance Company, UNG Prescription Plan, along with other information on deductibles, phone numbers for claim, etc. The problem is that having the names of these companies on the card doesn’t tell you if the plan is insured or self-funded. It is common for a company like Arkansas Blue Cross and Blue Shield to serve as a third-party administrator, or someone who provides customer service, claims administration, provider networks and other services for self-funded plans. Their name may be on the card, but that doesn’t mean the plan is insured.
Does this matter? It matters a lot. Insured plans, or those whose customers pay premiums for insurance coverage, are regulated by the Arkansas Insurance Department. Self-funded plans, or those employer-sponsored plans where the employer is carrying the risk, are regulated by the U.S. Department of Labor.
Knowing who regulates the plan determines what your options are when filing complaints. Your options are many if the plan is regulated by the state of Arkansas. AMS and others have passed numerous laws designed to provide help for physicians, patients, and other providers such as any willing provider, prompt payment, prior authorization restrictions, timely credentialing, and now, Act 706. However, most self-funded plans are regulated by the Department of Labor and are exempt from our state insurance laws; thus, those rotections are not available. Filing a complaint with the Department of Labor is usually an exercise in
So, now comes Act 706. Simply stated, it requires health care payors to indicate on the card whether or not the plan is “insured” or “self-funded.” The law went into effect on April 4, 2019, and applies upon renewal of the plan. Is this the “be all that ends all” solution to all your problems? Of course not. It’s really a small piece of a much larger puzzle. But you know how puzzles are solved … one piece at a time.
-David Wroten, EVP, Arkansas Medical Society