As we discuss in "Prodding insurers? Use patient power", collecting from recalcitrant health insurers requires persistence and, sometimes, a little help from the insured patient. When that doesn't work, you may need to call in the heavy artillery: the employer who contracts with and pays premiums to the insurer.

Send the employer this letter, edited to reflect your specific situation and the laws of your state. Copies of the letter, developed by Judy Bee and Jeffrey J. Denning of Practice Performance Group in La Jolla, CA, should also go to the patient and the insurer.

"My physician clients tell me that when they get the patient and/or employer involved, the plan managers pay attention," says Bee. "After you've contacted the patient's employer, give the carrier two weeks to come through with payment. If reimbursement still isn't forthcoming, report the carrier to the appropriate regulatory agency—usually the insurance commissioner. Your practice also might want to consider severing ties with a carrier that's consistently delinquent." .