05/08/2025
Are Insurance Companies Automatically Downcoding Your Claims?
We need your help!
OSMA members across the state report that insurance companies are automatically downcoding or even refusing to pay certain levels of claims. This is costing practices hundreds of thousands of dollars a year in lost reimbursement, and hundreds of hours of staff time to appeal claims to get paid at the correct amount.
To address this abusive practice, OSMA is supporting SB 165, introduced by Senator Susan Manchester, that would ban insurers from automatically downcoding claims in Ohio.
SB 165 is one of eight bills recently introduced in the Ohio legislature and supported by OSMA that address the administrative burdens being placed on physician practices and patients across Ohio by insurers. The burdens impact every physician regardless of specialty or where you practice. Reforms are needed now and OSMA is leading the way.
You can help with these reform efforts...
If you have had claims downcoded, we need to hear from you. We need examples of the type of claims you are having downcoded, and in general, what percentage of the time when you appeal the insurer then pays back to the initially billed level. Please email info@osma.org or call our office 614-527-6762 to share your story that will help with our legislative advocacy.
We need all physician hands on deck to ensure these insurance reform bills pass in the Ohio legislature! If you have colleagues who are not already part of OSMA, please share this message and encourage them to join our membership.