Moda Health Responds to Complaints about Payment Delays

Mental health professionals insist the insurer is holding up payments.

Mental health practitioners insist that Moda Health is holding up their claim payments, at times for up to 90 days, to make sure people haven’t canceled their insurance policy.

If that’s true, Moda would be in violation of the state’s prompt payment law requiring insurers to pay claims within 30 days.

“It sounds either like Moda is unaware of Oregon's prompt pay law, or that they don't see the law as applying to them,” a mental health therapist told The Lund Report, but was unwilling to share their name because of the fear of repercussions.

Moda spokesman Jonathan Nicholas flatly denied his company was delaying payments, and insisted they treat everyone equally.

“There’s no system where mental health providers are being paid under one timeframe, while chiropractors or dermatologists or primary care physicians or any other specialty might be paid under another,” he told The Lund Report.

“The timing for paying claims varies depending on the time of year, on the amount of time it may take for us to receive the claim, and the complexity of the claim,” he added. “We do usually see an increase in claims activity in the 4th quarter, which can increase payment times through into the first quarter of the following year. We also typically see a delay in the ACA market in the 1st quarter of each year due to the time it takes to verify members’ eligibility. And, yes, these issues have been exacerbated this year because of all the uncertainty around the individual market and ongoing concerns about whatever changes might be in store for 2017.”

Nicholas encouraged providers or members who have questions about a specific claim to call Moda’s offices at 1-888-217-2363, and “we’ll be happy to help him or her in any way we can.”

Under the prompt payment law, insurers must pay clean claims within 30 days. If they need additional time, insurers must notify the provider and patient within that time frame and either pay or deny that claim within the next 30 days, according to Mark Peterson, Insurance Division spokesman.

Insurers that fail to comply with these regulations can be fined or sanctioned, he added. Although practitioners can file a complaint with the Division, such information is not available publicly. “

Under state law, we do not provide detail on the nature of our complaints. However, if any providers feel that they need assistance for timely payment, they should contact the Division of Financial Regulation,” Peterson said.

Diane can be reached at [email protected].

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