How Healthcare Payers are Tricking Practices Into Poor Contracts

April 19, 2014

Payers are using deceptive methods to get medical practices to accept low rates and new plans. Don't fall into the trap.

Something happened the other day, and I wanted to share it with you.  It seems that since there are so few providers in-network with the plans offered through the health insurance exchanges, Blue Shield is really reaching to try to get practices to sign up.

I have noticed that they are faxing over mini forms for front-office staff to fill out. The forms state that Blue shield needs to "update our records with your current information."

The problem is that the forms act as a contract and upon signing them and faxing them back, practices are stating that they will see patients at a VERY reduced rate than what they are accustomed to receiving. 

It's a very deceptive tactic, because your front-office staff will do anything they can to help you out and take care of distracting paperwork. 

You must tell them to be very aware of anything from any insurance company asking to “update your information."  This is also how you unknowingly become contracted with plans.  It's almost like a phishing scheme and should be illegal.

Blue Shield is also using NPI numbers and mailing a “credentialing contract” directly to the homes of providers.  Yes, Blue Shield does require credentialing, but those documents are always sent directly to your practice's main mailing address where checks and payments for services are sent. 

These contracts should never be sent directly to any home addresses.  Like your helpful front-office staff, your practitioners will also try to help you out by filling in the required information and mailing or faxing the form back to the insurance company. This could lock you into an awful reimbursement rate.

Blue Cross made a surprising move this week. Instead of the deceptive tactics used by Blue Shield, it is actually honoring the current rate with the contract that already exists.  As shocking as it was to read that letter, I believe this move better addresses the actual issue: To get their customers and your patients in the door to be seen. 

Why is it that the physician has to pay the price for a poorly executed roll out of the Affordable Care Act? You shouldn't. 

Enlist your staff members' help in making sure you do not sign up for a plan you had no intention of taking.  Sit down with them for a moment and explain what is going on so that they are aware.  If something does come in the mail or across the fax machine, have them deliver it to you or your contracts department immediately.