I recently heard what I find to be a crazy story from a psychiatrist based in Massachusetts. I can’t find any articles about this practice online, but if there’s a kernel of truth to this, I’d like to pitch it to a local newsroom I’m affiliated with.
The psychiatrist said that she and a lot of her colleagues have phased out of working with health insurance companies because of what she calls claw backs.
She says claw backs are a method health insurers such as Blue Cross Blue Shield use to reclaim reimbursed money, not from plan subscribers, from their healthcare providers.
As more people began using benefits over the past few years, she says that BCBS ramped up internal efforts to compare subscriber plans to their external existing benefits, for instance through an unrelated work policy.
So if a plan subscriber might have received benefits from a separate policy, BCBS sends the healthcare provider a bill demanding the return of their reimbursement.
She says that BCBS has proposed health care providers work off the balance of this claw back with a lump sum payment or in future reductions from care provided to BCBS plan subscribers.
Can anyone shed some light on this? What would the “claw backs” division or job title be called? Is this a trend within the healthcare insurance industry?
submitted by /u/CorrectApplication65
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I recently heard what I find to be a crazy story from a psychiatrist based in Massachusetts. I can’t find any articles about this practice online, but if there’s a kernel of truth to this, I’d like to pitch it to a local newsroom I’m affiliated with. The psychiatrist said that she and a lot of her colleagues have phased out of working with health insurance companies because of what she calls claw backs. She says claw backs are a method health insurers such as Blue Cross Blue Shield use to reclaim reimbursed money, not from plan subscribers, from their healthcare providers. As more people began using benefits over the past few years, she says that BCBS ramped up internal efforts to compare subscriber plans to their external existing benefits, for instance through an unrelated work policy. So if a plan subscriber might have received benefits from a separate policy, BCBS sends the healthcare provider a bill demanding the return of their reimbursement. She says that BCBS has proposed health care providers work off the balance of this claw back with a lump sum payment or in future reductions from care provided to BCBS plan subscribers. Can anyone shed some light on this? What would the “claw backs” division or job title be called? Is this a trend within the healthcare insurance industry?
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