Anyone with a good resource for the usual lag betweem date of service and payment by a commercial or employee plan?
For Rx, it’s like a day. But for the other stuff where there is a billing lag and a payment lag - what should someone anticipate?
Wouldn’t it vary a lot by company?
It depends quite a bit on the type of provider and the state. Office visits tend to get billed fairly quickly but inpatient stays are very slow, sometimes months. There’s a limit because most carriers won’t pay if it is beyond a certain time period, like six months. The lag between when a carrier receives the bill and when they pay depends too. Are you talking about how quickly it is processed or actually paid? Some carriers only issue checks on certain days. The last time I worked on a line of business and dealt with this kind of stuff our average process time was about a day (because like 95% of claims were auto-processed) but time to payment was three days because we only paid providers twice a week (even though we weren’t actually printing physical checks any longer). Most states have a statutory maximum on how long a carrier has to make payment on a claim or they owe a penalty. I recall it being 45 days in general with TX being shorter but I don’t trust my memory that much in this case.
I’m not certain if you’ll find this published anywhere. I think most carriers and providers would consider it proprietary. It has always been fairly easy to analyze internally at the places I’ve worked because the dates have been stored since they are important for auditing and legal matters.
And maybe the provider too.
I just looked at a couple of my own EOBs, an Urgent Care visit and a telehealth visit. The EOB itself didn’t have a date but I have emails for when I was billed.
Urgent Care took a week from date of service to letting me know how much I owed. PCP/telehealth took 3 weeks.
Prescriptions usually come through in 2-3 days.
I feel like my insurance company is pretty quick on these simple things, and any delay is on the provider side. I imagine hospital visits and surgeries would take a bit longer. And I don’t know how my insurance company compares to others.
Don’t forget holidays!!!