July 17, 2024

The Health

Your health, your choice

Northwell Direct plagued with billing problems, health care providers say

Doctors, therapists and other providers in the health care benefits plan for Northwell Health employees and their families said they have been hit with billing problems and months of delayed payments since Northwell switched its third-party administrator on Jan. 1.

Payments for appointments as far back as January haven’t been received, or weren’t received until April, some providers told Newsday.

Leslie Marino, president of the Suffolk County Medical Society, said providers have had “numerous issues” with the Northwell Direct network. In addition to delayed or missing payments, providers have received incorrect payments and had difficulties getting assistance from representatives through phone or email. She said it’s a common problem with the use of third-party administrators to process claims.

“It’s an unmanageable and ultimately unfair system which drives providers away from accepting insurance,” said Marino, a psychiatrist in Babylon.

Northwell Direct, a for-profit company owned by the nonprofit Northwell Health, provides health benefits to 85,000 Northwell employees and 20,000 members from other employers and labor unions. Based in New Hyde Park, Northwell Health is the state’s largest health care provider and private employer.

In an interview, Northwell Direct CEO Nick Stefanizzi acknowledged many of the problems and traced them back to the switch of its third-party administrator from MagnaCare to HealthComp to process claims.

“A transition of that magnitude … is quite significant,” Stefanizzi said. “We wanted to put in some additional quality control and payment reviews before we started to release first payments because we wanted to make sure that the providers were going to be paid correctly.”

Another roadblock, he said, was the February cyberattack at Change Healthcare, which processes billions of health care transactions every year — including those from Northwell Direct. The disruption led to a backlog of claims.

Providers send insurance claims to Change Healthcare and then those claims go to HealthComp for adjudication and processing.

“We appreciate that these last few months have been incredibly challenging for providers with the disruption that was created by Change,” Stefanizzi said.

But whether it’s an incorrect payer code, billing code or some other administrative issue, providers told Newsday they are having trouble getting information about how to fix problems.

Mary Ellen Kundrat, a Nassau County-based licensed clinical social worker, said she has not been paid for appointments she held in January. She acknowledged that despite her best efforts, she may have made some initial errors because she found the claims process confusing.

“My lack of knowledge on these systems should not be an impediment to earning a living,” Kundrat said. “I do feel that small, single-owner businesses like mine are expected to ‘just deal with it’ while larger practices can pay for someone to handle these issues for them.”

She added: “Every hour I have to spend dealing with insurance companies is an hour I am unable to see clients.”

The most helpful information she has received was from social media pages, she said, where providers have shared their experiences.

Kundrat echoed the concerns of other Long Island providers who spoke with Newsday but declined to be quoted. 

While Stefanizzi noticed there was an uptick in calls and questions about the changeover, he said he was not aware providers were having trouble getting information from HealthComp.

“We had worked with them on messaging and what we could share,” he said.

Stefanizzi said 500,000 claims have been received since Jan. 1 and less than 400 are outstanding. He also said 97% of claims are processed within 30 days.

Kundrat and others believe, however, that a number of outstanding claims they tried to submit may have not been received.

Northwell Direct sent a letter to providers at the end of March acknowledging the delays and asking for patience.

Despite that, providers said problems have persisted.

David Podwall, president of the Nassau County Medical Society, said Northwell should have done more to explain what happened.

“These practices are waiting on money from the Change Healthcare fiasco; they are waiting on HealthComp to fix their own problem,” said Podwall, a neurologist in New Hyde Park. “That is different from them being proactive and contacting practices and telling them how they will rapidly fix this issue.”

Doctors, therapists and other providers in the health care benefits plan for Northwell Health employees and their families said they have been hit with billing problems and months of delayed payments since Northwell switched its third-party administrator on Jan. 1.

Payments for appointments as far back as January haven’t been received, or weren’t received until April, some providers told Newsday.

Leslie Marino, president of the Suffolk County Medical Society, said providers have had “numerous issues” with the Northwell Direct network. In addition to delayed or missing payments, providers have received incorrect payments and had difficulties getting assistance from representatives through phone or email. She said it’s a common problem with the use of third-party administrators to process claims.

“It’s an unmanageable and ultimately unfair system which drives providers away from accepting insurance,” said Marino, a psychiatrist in Babylon.

WHAT TO KNOW

  • Doctors, therapists and other providers said they have been hit with billing problems and months of delayed payments from the health care benefits plan for Northwell Health employees and their families. 
  • Northwell Direct, a for-profit company owned by Northwell Health, acknowledged problems and traced them back to a switch of its third-party administrator in January, as well as problems from a nationwide hack of Change Healthcare.
  • Providers also told Newsday they are having trouble getting information about how to fix problems.

Northwell Direct, a for-profit company owned by the nonprofit Northwell Health, provides health benefits to 85,000 Northwell employees and 20,000 members from other employers and labor unions. Based in New Hyde Park, Northwell Health is the state’s largest health care provider and private employer.

In an interview, Northwell Direct CEO Nick Stefanizzi acknowledged many of the problems and traced them back to the switch of its third-party administrator from MagnaCare to HealthComp to process claims.

“A transition of that magnitude … is quite significant,” Stefanizzi said. “We wanted to put in some additional quality control and payment reviews before we started to release first payments because we wanted to make sure that the providers were going to be paid correctly.”

Another roadblock, he said, was the February cyberattack at Change Healthcare, which processes billions of health care transactions every year — including those from Northwell Direct. The disruption led to a backlog of claims.

Providers send insurance claims to Change Healthcare and then those claims go to HealthComp for adjudication and processing.

“We appreciate that these last few months have been incredibly challenging for providers with the disruption that was created by Change,” Stefanizzi said.

But whether it’s an incorrect payer code, billing code or some other administrative issue, providers told Newsday they are having trouble getting information about how to fix problems.

Mary Ellen Kundrat, a Nassau County-based licensed clinical social worker, said she has not been paid for appointments she held in January. She acknowledged that despite her best efforts, she may have made some initial errors because she found the claims process confusing.

“My lack of knowledge on these systems should not be an impediment to earning a living,” Kundrat said. “I do feel that small, single-owner businesses like mine are expected to ‘just deal with it’ while larger practices can pay for someone to handle these issues for them.”

She added: “Every hour I have to spend dealing with insurance companies is an hour I am unable to see clients.”

The most helpful information she has received was from social media pages, she said, where providers have shared their experiences.

Kundrat echoed the concerns of other Long Island providers who spoke with Newsday but declined to be quoted. 

While Stefanizzi noticed there was an uptick in calls and questions about the changeover, he said he was not aware providers were having trouble getting information from HealthComp.

“We had worked with them on messaging and what we could share,” he said.

Stefanizzi said 500,000 claims have been received since Jan. 1 and less than 400 are outstanding. He also said 97% of claims are processed within 30 days.

Kundrat and others believe, however, that a number of outstanding claims they tried to submit may have not been received.

Northwell Direct sent a letter to providers at the end of March acknowledging the delays and asking for patience.

Despite that, providers said problems have persisted.

David Podwall, president of the Nassau County Medical Society, said Northwell should have done more to explain what happened.

“These practices are waiting on money from the Change Healthcare fiasco; they are waiting on HealthComp to fix their own problem,” said Podwall, a neurologist in New Hyde Park. “That is different from them being proactive and contacting practices and telling them how they will rapidly fix this issue.”

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