It is well-known in the medical billing industry that most insurance companies (payors) follow the 3 D’s:
They want all medical providers to accept “their” discounted rate.
They routinely deny payment for whatever reason they can come up with.
They try to delay paying the provider for as long as they can.
As a medical billing company, we have to work with each payor for each of our medical providers.
Sometimes the medical provider has to enroll with a payor and accept the payor’s discounted rate or else the provider will not be able to provide service to the payor’s members.
When a payor denies payment, we have to evaluate that denial to come up with an appeal of that denial so that the provider will be paid.
When a payor delays payment, we have to identify the unpaid (delayed) claims and make sure that the claim is re-submitted to avoid a timely-filing denial.
The insurance companies set up the rules and the providers as well as their billing companies, like MedNet Resources, have to follow those rules.
