In November, many Summit County independent medical clinics expressed frustrations with the way health insurance provider Bright Health handled its claims processing. A couple of these clinics, such as Ten Mile Health & Wellness in Dillon and Swan Mountain Women’s Center in Breckenridge, said they were out thousands of dollars as they waited to be paid for their services.
Some of these issues have been resolved two months after leaders at Bright Health promised change, but these two clinics are still guarded as a portion of their claims remain outstanding.
The issue came to a head last year at the beginning of the health insurance enrollment season. Some clinics began coming forward about Bright Health and voiced discontent about how the company had yet to reimburse them for services provided to patients that were done six months ago, or sometimes even longer. In some cases, some claims were paid incorrectly, too.
In addition to Ten Mile Health & Wellness and Swan Mountain Women’s Center, those who had expressed issues with claim processing also include the Ebert Family Clinic and the Summit Community Care Clinic.
As some clinics began banding together to share their grievances, it got the attention of Peak Health Alliance, a local nonprofit health insurance purchasing alliance that was founded in Summit County and negotiates lower insurance rates for Coloradans in rural areas. Bright Health is the chosen carrier of Peak Health Alliance, and it worried the organization’s leaders about whether these issues were great enough to cause these clinics to separate from Bright Health altogether. If this were to happen, individuals who are insured by Bright Health would have less options for health providers.
Peak Health coordinated a forum in November where Bright Health Colorado Market President Curt Howell had the opportunity to speak with the leaders at some of the clinics. During the meeting, Howell apologized on behalf of the company’s handling of claim payments and made a promise that these issues would largely be fixed within 90 days.
About 60 days into that promise, Dr. Theresa Clark, psychiatrist and owner of Ten Mile Health & Wellness, said that the majority of her claims have been paid but that there are still outstanding claims — some of which are nearly a year old — that have yet to be resolved. While this is largely good news, Clark said she still had reservations about Bright Health moving forward.
“Overall, I still have concerns because they still owe money that is outstanding and, from what my biller has said, some of the newer claims are still being processed with errors, so I definitely still have concerns that we’re going to continue having these issues going forward,” Clark said. “Am I at least hopeful that things will still improve? Sure.”
Sarah Leone, billing coordinator for Ten Mile Health, wrote in an email that of the claims that were outstanding before the November meeting, 88% of those have been paid. This amounted to about 70 claims, totaling roughly $20,000 that was owed to the clinic.
As of Friday, Jan. 21, Leone said there are still about 24 claims that are outstanding, amounting to about $4,470 owed to the clinic in addition to another $3,700 owed from Bright Health’s Medicare division.
Leone wrote in an email that, of the claims that have been submitted since December, she estimates that 85% have been paid on time and correctly, which she commended the company for. Even still, she said it continues to “create problems for itself.”
“While the old claims with problems are being addressed, new claims are being submitted daily that Bright Health continues to process incorrectly so the total number of outstanding claims creeps up over time,” Leone wrote.
Dr. Andrew Catron, co-owner of Swan Mountain Women’s Center in Breckenridge, echoed these sentiments. A large enough portion of his claims have also been paid to where he is no longer weighing whether to separate from the carrier. However, he said he has a considerable amount of claims still outstanding.
“In my practice, we have nearly $55,000 in claims outstanding that are over 120 days old, including one claim that is just over a year old where we submitted the claim correctly and Bright inappropriately denied it,” Catron said.
That is just the amount outstanding that is over 120 days old. In total, Catron said his clinic is still owed $75,000. In November, it was $80,000.
Even with this amount of money owed, Catron said Bright Health leaders have shown a strong willingness to do better. Catron said Howell has been very responsive and that the company, and its leaders have repeatedly said his clinic has done everything correct and that it’s now on Bright Health’s end to resolve the issues. Because of this, Catron said he’s willing to wait out the next 30 days to see whether his outstanding claims will get resolved.
As for Peak Health Alliance, spokesperson David Rossi said the organization is very pleased with the steps Bright Health has taken since the November meeting, one of which included designating a new point of contact for some of these clinics.
“Bright did live up to their commitment made at the meeting of bringing in a dedicated person for Peak providers that providers could reach directly without having to be put through their call center issues,” Rossi wrote in an email. “They also did bring in this oversight committee to help identify issues.”
Bright Health did not respond to a request for a comment before deadline.