Wiki Self Funded Ins. Plan owe Interest

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I am wondering if anyone can help guide me to the rule that states that a self funded insurance plan would not require to pay interest for a claim that was paid after submission approximately a year later. I challenged a payment with ASH as they are a third party that handles Chiropractic benefits for many BCBS and Cigna Members with our office. I was not under the impression that anyone was exempt from paying the interest penalty.

Please help-

Thank you,
Tessa
 
There isn't a 'rule' that you'll find that says this - rather, it's actually something of a loophole in the rules. Insurance policies are regulated by state law - each state's insurance commissioner has the authority to govern the policies that are offered within the state, to approve the policies and the premiums can be charged, and to apply regulations including those that govern timely payments, interest, limits on recoupments, etc. The loophole is that self-funded plans are legally not considered insurance policies - no 'policy' is sold to the member, and there is no premium that is based on risk factors. Rather, the employer chooses to fund their own employees' healthcare costs, effectively becoming a sort of 'self-pay' entity. The companies that administer these plans are not acting as an insurance provider, but are simply hired by the employer to administer the benefit by paying the claims directly out of the company's own funds. As such, these payments are not subject to state insurance laws and are outside the jurisdiction of the state insurance commissioner.
 
Hi- Someone is always held responsible :) The employer is held liable for the TPA. I would have your eop, timely filing documents from your clearinghouse and print out from your POS system showing when claim was billed and excepted. Your EOP will confirm when payment was paid. Then contact employer. Your state should have a clean claim payment rule or somthing. Hope this helps. Thanks
 
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