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Doctors, Insurers Butt Heads Over Insurance Claims
Updated May 5, 2013 12:06 AM
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(INDIANAPOLIS) - What might seem an arcane question of how insurance claims are processed is the subject of a fierce lobbying battle between doctors and insurance carriers.

Several doctors' groups, including the Indiana State Medical Association, Indiana Dental Association and Mental Health America-Indiana, are backing a bill to require insurers to make payments directly to providers if that's what the patient wants.

Such arrangements have been common in Indiana, but an increasing number of PPO networks are refusing to do so for out-of-network providers.

Doctors contend the refusals create confusion for patients, who may not know what the check in their mailbox is for. That either delays payments to the doctors or forces them to demand full payment up front.

Doctors accuse insurers of trying to "strong-arm" them into joining networks. The Indiana Chamber of Commerce and Indiana AFL-CIO have found unusual common ground in opposing the bill, arguing it would push more doctors out of PPO networks and push premiums up.

Delta Dental, the state's largest dental-insurance network, stopped honoring so-called "assignment of benefits" agreements seven months ago.

Senior Vice President Jed Jacobson says seven-percent of Indiana's dentists have joined the network since, boosting the network's membership to 60-percent. Jacobson told the senate health committee PPO membership saves the average Delta family $152 a year.

The committee may vote on the bill next week.



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