State Senator Sal DiDomenico recently met with members of SEIU Local 509’s CliniciansUNITED group to discuss “An Act to limit retroactive denials of health insurance claims for mental health and substance abuse services,” also known as the Clawback Bill. Senator DiDomenico is a cosponsor of this legislation which establishes fair parameters around the health insurance practice of reverting payments (clawbacks) for which providers of behavioral health services had received previous authorization and been paid by health insurers.
“It was a pleasure meeting with SEIU 509 CliniciansUNITED to discuss our shared support for the Clawback bill,” said Senator DiDomenico. “Insurance clawbacks create an administrative nightmare for providers and often leave them unpaid for the services they have provided. When providers comply with the rules and deliver services in good faith, they should absolutely be compensated without concern that insurance companies will take back these reimbursements months or even years after the services were provided. I’m proud to support legislation that seeks to remedy this problem.”
Currently, healthcare providers check a client’s insurance status before providing services to patients, and are required to follow any insurance prior authorization requirements. They are then required to meet a billing deadline – usually 60 or 90 days.
In contrast, health insurers then have an unlimited time to retract payment if they discover the patient was not covered, even though they authorized the services and paid the claim. This often happens years after the service was provided, when it is too late for the provider to bill the correct insurer due to timely billing requirements of insurers. As a result, patients receive the service they need, the insurer is no longer responsible for payment, and the provider is left without payment.
This legislation would limit both MassHealth and commercial health insurers to a six-month period for recovering payments to a behavioral health provider for completed services. Twenty-four other states have imposed time limitations within which an insurer may retroactively deny and/or adjust claims and demand reimbursement from providers.
This legislation has been an important priority for the Senate. The stand-alone Clawback Bill, S.582, is currently pending before the Joint Committee on Financial Services, of which Senator DiDomenico is a member.