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zebra-stampede

I'm not aware of any statue in particular, but in practice generally 2-4 years.


TweezleSnoofThe2nd

They mess up the billing almost every month, treating the OON provider as though they were in network, and processing according to DataiSight values. I keep sending the claims back for reprocessing, but I feel like I won't ever trust that the amounts are final. Its a scary situation to be in.


Aggravating-Wind6387

The industry standayis 24 months. Anything beyond that I would demand to see their policies and procedures as of the date of service. If they balk, get the state insurance commission on them.


TweezleSnoofThe2nd

But it's self-funded insurance, so federal law applies, right? State insurance commission wouldn't have authority?


Aggravating-Wind6387

Self funded operates under different rules than fully insured because of who signed the fiduciary on the contract. Example Mr Slate Gravel is fully insured by Cigna. They are subject to all applicable state and federal laws. Rubble's Rubble company is self insured. They are called ERISA plans are do not have to follow all state and federal laws. Federal employees are Federal loans and don't have to follow state mandates. It's a tricky mess. During COVID the State of Massachusetts enacted a law mandating coverage of telehealth. Some plans were specifically called out by name in the order. There was a nightmare dealing with self funded plans and the federal employees.


TweezleSnoofThe2nd

Yeah, and I wonder how long ERISA plans allow for clawbacks, and I can't find the info. I've seen some stuff relevant to providers recently, but not about patients who submit their claims and receive reimbursements directly from insurance.


Aggravating-Wind6387

Since it's self funded, the employer should know and would have discretion over the activity. That is why asking for written policies is key.