Business ProfileforSierra Health and Life Insurance Co.

HEALTH CARE PROVIDERS SHOULD AVOID DOING BUSINESS WITH SIERRA HEALTH AND LIFE INSURANCE, INC. In Sept. of 2019 they made correct payment on a health insurance claim. Almost 2 yrs later they sent a letter requesting some of the payment back. We tried working with them to resolve this, but ended up sending it to Appeal. No action should be taken when a claim is in appeal. It was noted 2 times in the patients record to hold until appeal was processed, yet Sierra Health continued to send letters requesting repayment or threating to send us to collections. On 11/8/21 we received an EOB from Sierra Health with their outcome. At the same time we received a letter from a collection company demanding repayment. We contacted the collection company and asked why we were sent to collections before we received the appeal outcome. We were told that Sierra Health anticipated the appeal outcome so they sent us to collections before the appeal decision was made. This is a very unethical company. They say they follow a providers contact to make payment on claims but that is not the case. Even when provided with the providers contract showing the amount of payment due, they still upheld their decision and sent our provider to collections before the appeal decision was determined.

Sierra Health and Life has researched the information included in this review and confirmed the correct process was followed per standard claims processing guidelines.

I have been working in the health insurance industry dealing with claims and appeals for the past 15 years. Every provider has a right to appeal a claim decision by an insurance company. Never in that time has one of my providers been sent to collections by any other insurance company before the appeal process has been completed and the outcome has been communicated to the provider. This is an unethical practice and NOT standard claims processing guidelines.