Oklahoma Insurance Commissioner Angry With Claims Backlog

Oklahoma Insurance Commissioner Kim Holland said she is “grossly disappointed and frankly mad” about a continuing backlog of more than 200,000 unpaid health insurance claims in a state workers’ insurance plan.

“That is just absolutely unacceptable,” Holland said of the backlog at the HealthChoice plan that some state lawmakers said is causing cash-flow problems at hospitals and forcing some health care providers to refuse to honor the insurance plan and demand cash for their services.

“It’s very, very disappointing. I’ve just pretty much run out of patience,” Holland said.

She said officials are working on a plan to make prepayments to providers whose claims are caught up in the backlog, which could take months to eliminate.

“I think we need to get some money in providers’ hands,” Holland said.

“It’s challenging, obviously, for hospitals,” said Rep. Jeff Hickman, R-Dacoma, adding that if claims are not paid in a timely manner, “those numbers add up.”

“I’ve had dentists that are having trouble getting paid,” said Rep. Lewis Moore, R-Arcadia. Moore said he plans to conduct a news conference next week with officials from the Oklahoma State and Education Employees Group Insurance Board and the operator of a new system for health, life and dental claims processing at HealthChoice, EDS.

Bill Crain, the administrator for OSEEGIB, has said the new claims payment system for the health care plan was supposed to be up and running by Jan. 1. But the new system did not begin running until the end of January.

Meanwhile, the claims backlog has been as high as 270,000, Crain said. The current backlog is 211,895 claims.

“EDS has made some strides recently in improving the situation. But (it’s) not nearly where we would like for it to be,” Crain said. “We continue to believe that they will make progress. And we are continuing to work with them and providers to try to help as much as we can.”

As of March 23, more than 447,000 claims have been processed by EDS, totaling more than $71 million in payments, according to the HealthChoice Web site.

“That’s not where we need to be,” Crain said.

He said the insurance plan receives 50,000 claims a week and that an average of between 15,000 and 20,000 claims need to be processed each day to take care of the backlog.

“The problem is EDS made commitments they have not lived up to,” Holland said. “We didn’t engage them to learn on the job.

“They’ve got a lot at risk here, and they know it. EDS created this mess. They can figure out how to fix that.”

Crain has said that EDS, which will be paid between $16 million and $17 million a year for claims processing services, will face penalties for the delay in claims payments. State law mandates a penalty of 10 percent simple interest on claims older than 45 days, Crain said.

“It’s a terrible situation that we deeply regret,” Crain said. “Quite honestly, our providers have just been terrific. They’ve been very patient and they’ve been very cooperative. As time goes by, that wears thin.

“We’re just doing everything we can to make a bad situation better.”