Unsigned forms delaying insurance claims

MORE than €7.8 million is outstanding from insurance companies as a result of unsigned forms from consultants at Galway University Hospitals, including €496,000 for one consultant, it has emerged.

The Health Service Executive (HSE) has confirmed that the total amount unclaimed from insurance companies is €15.5m as of last August, of which €7.8m has not even been sent to insurance companies from consultants at University College Hospital and Merlin Park.

The failure of one consultant to sign forms that would release almost €500,000 to the HSE was described as “outrageous” by HSE West Forum chairman, Councillor Padraig Conneely.

Assistant national director for finance, Liam Minihan, revealed at a recent HSE West Forum meeting that a consultant at Galway University Hospitals has yet to sign forms for private insurers that would release €496,000 to the HSE.

Councillor Conneely called for the unnamed consultant to be denied access to private beds at the Galway University Hospitals until the matter is resolved. The former Mayor of Galway City also requested HSE officials at the meeting to name the consultant but his request was not granted

Councillor Conneely said no action seemed to be taken against consultants who have not signed off on insurance claim forms at a time when public acute hospitals desperately require funding.

During the negotiations between the HSE and consultants concerning a new consultants’ contract, Councillor Conneely claimed the case of one consultant who had €340,000 in outstanding claims was cited.

Considering most consultants earn over €200,000 and have access to private beds in public hospitals, he deplored the fact that one consultant has so much insurance money outstanding.

Tony Canavan, the chief operating officer of the Galway and Roscommon University Hospital Group, stressed progress is being made in relation to this issue and noted the level of co-operation with consultants is significant.

Regional director of operations, John Hennessy, admitted the issue is a source of huge frustration across the public health services, which would be addressed under the new consultants’ contract.

As part of new work practice reforms to be agreed with consultants, assistant national finance director, Francis Rodgers said the consultant will complete and sign off on private insurance forms within 14 days of receiving the documentation to ensure a timely and efficient process, as well as co-operating with a new online system to speed up payments.

However, Councillor Conneely argued that having €5.8m in unsent, unsigned claims isn’t much progress and pledged to monitor this issue over the coming months.

Galway University Hospitals were €11.9m, or 8%, over-budget at the end of July. In a report, the chief executive of the Galway Roscommon Hospital Group, Bill Maher, said that at the end of August, the amount outstanding from insurance companies at the group of hospitals was €15.5m.

He added, “That is €7.7m sent and €7.8m not sent to the insurance companies. There are a number of reasons why claims would not be sent. The principal one is that the consultant signature is awaited. This accounts for €5.8m of unsent claims.

“The hospital group are working closely with clinical directors to reduce the amount of outstanding debt relating to the non-signature of claims. Progress to date has shown a decrease of about €400,000 in a two-week period. It should be noted there will always be a time factor equivalent to €3m outstanding at any time,” he said.