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St. Lawrence County legislators raise concerns over insurance claim denials

Posted 1/29/23

BY JEFF CHUDZINSKI North Country This Week CANTON — St. Lawrence County has not been receiving accurate insurance reimbursement, prompting legislators to approve a new contract with EPOCH Health …

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St. Lawrence County legislators raise concerns over insurance claim denials

Posted

BY JEFF CHUDZINSKI
North Country This Week

CANTON — St. Lawrence County has not been receiving accurate insurance reimbursement, prompting legislators to approve a new contract with EPOCH Health Solutions, LLC to review billing practices in the Community Services Department.

Officials approved the resolution during the services committee meeting on Jan. 23.

Director of Community Services Jay Ulrich told legislators it would cost $8,500 for the contract.

Officials say billing efficiencies in Community Services has been a concern for some time, prompting the action.

A comprehensive review of old billings is currently ongoing as officials attempt to pinpoint deficiencies and errors, Ulrich told legislators.

When asked about the specifics of the deal, Ulrich told legislators it was scaleable, with EPOCH offering a number of services and solutions for the county. Legislators wondered whether EPOCH would be able to assist directly when insurance billings were turned back by the insurance companies.

“When those bills get turned down, don’t they give us a reason? Or do they just say ‘sorry, we’re not going to honor this’,” Legislator Joseph Lightfoot asked.

According to Ulrich, the department is given a code that corresponds to the denial but then are forced to decipher what the specific code means.

Services Committee Chairman Ben Hull told legislators that codes appear to be deliberately vague when insurance companies deny a claim.

Lightfoot then asked if it would be possible to receive further information to clarify what the code might mean or why the claim was denied but according to Ulrich, insurance agencies are not always helpful when asked.

In some cases, coders will reach out to the insurance companies directly for assistance to mixed results, Ulrich said.

“Are you sure this will take care of this issue to eliminate the number of returns and refusals,” Lightfoot asked regarding the new contract.

“I’m confident this will move the needle in the right direction given the experience thus far,” Ulrich responded.

Staff members are also trained by the county as well as EPOCH, Ulrich elaborated. The comprehensive training program is something that all new staff undergo, he continued.

“So that to me sounds like this is built in by the insurance companies not giving you a straight answer, or whatever, to avoid paying for these things. I almost look at this as a well thought out plan. That’s a lot of you know what. So what’s the answer? Is the answer spending six thousand dollars on EPOCH or is there some way some of our representatives in Albany couldn’t address this with some kind of legal…law or statute that would require these outfits…my god they come up with enough stupid stuff, they could certainly come up with something that would benefit their constituents,” Lightfoot responded.

The resolution passed unanimously and now moves to the full board for approval.