Insurance

Prompt Pay Act: Upholding the Rights and Interests of Doctors

Posted by on Jan 6, 2015 in Insurance | 0 comments

The significant decline in the purchase of private health insurance in the US can be attributed to two factors: high unemployment over the past years and the high cost of health insurance premiums. For wage earners, especially those in the middle income bracket, losing a job did not only mean lost wages, but of health care benefits too, which were actually employer-sponsored.

The cost of health insurance, on the other hand, which many health care and business experts believe to be insanely expensive, has driven many to shelve it instead. The effect is reliance on public health programs, such as Medicare, Medicaid and the State Children’s Health Insurance Program. Public health programs, which were introduced by the Affordable Care Act of 2010 and which cover the health care needs of those who can no longer afford health coverage, now address the health concerns of more than 30% of the American population.

Whether having private coverage or availing of public health care benefits, there is one common negative effect, though; not to patients’ disadvantage, of course, but to doctors. For while many experts describe the American health-care system as a “fee-for-service” kind of thing, wherein health-care providers are believed to be very high earners, well, think again, because several of them end up as victims of many health-care insurance firms, experiencing low, delayed or denied compensation despite valuable service already rendered to the public.

To protect the interests and rights of medical care experts the Prompt Pay Act was enacted. As explained on the website of the Williams Kherkher law firm, this 2003 mandate is aimed at making sure that doctors who do not receive full compensation from insurance firms (within specific timeframes) for the medical treatment that they have provided “may be able to recover compensation through a legal claim.”

The law firm explains, however, that the mandate neither covers all insurance programs nor does it render all health-care providers entitled to compensation through the Prompt Pay Act. It will definitely be in the best interest of the physician, therefore, to seek sound and wise legal advice from highly knowledgeable and experienced prompt pay lawyers for a clear understanding of their legal rights and legal options.

Read More