My question involves insurance law for the state of: CA
I have a Dr. Office and Surgery Center that is non-par with United Health and HealthNet.
They are using MultiPlan as a third party administrator for price reduction. They have been reducing my client’s bills on a contractual rate, but there has never been a contract. We requested a copy of the contract and I called MultiPlan and there excuse is that, "there system shows an UP & UP contract and although the contract cannot be produced, our records verify our participation."
We also inquired on the passed claims that were processed a few years prior at a reduced rate. Their response was "Client are limited to a timeframe for reprocessing and as we were not aware of the disputed claims within those timeframes any claims over 365 days cannot be reprocessed. The majority of the claims submitted were 2-3 years old."
The letter then closed with, "We must insist that all related claims be accepted based on the terms of your agreement and that patients are not billed for any amounts shown on the payors remittance advice that are related to PHCS/MulitPlan."
Oh PS. They also terminated the contract as of 11/05/2008, per our request. We never had a contract that is why we asked them to terminate.
Again there is not contract nor are we the client. I would appreciate any assistance. AJ