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Providers are Fighting Illegalities from Insurance Payers


What is going on in healthcare right now has the potential to really affect your practice. Be ready and brace yourself for changes.

I attended the annual iPT Conference (Independent Physical Therapists) yesterday up in Long Beach, Calif.  As always, it was full of useful and pertinent information on the healthcare industry, many studies conducted showing insurance payers' lack of transparency, and how physicians of all types are starting to band together like brothers and sisters against insurance payers.

It started with an update on the One-Call / AlignNetworks lawsuit that iPT started in March of this year that has since moved to a Federal Court.  This is fantastic news for physical therapists across the country and they SHOULD get involved!   It's clear to see that Align, which is a workman's compensation provider, has been stealing money from hard working practitioners, and lying to employers about 'its role in driving patients to the practitioner who accepts the lowest payment.  The lawyers for iPT expect to have an outcome in the next month to forty-five days.

There is also a lawsuit going on with a group of chiropractic doctors, the Chiro Group and United Healthcare.  Lawyers are stating that United is not following the terms of their own health plans.  "The proposed class action takes aim at a practice called "cross-plan offsetting," in which United withholds payment to medical providers to account for overpayments previously made in connection with different participants in different United-insured plans."

At the conference, Jim Hall, founder of Rehab Management Services Medical Billing and a Private Practice Section Policy Committee member spoke about two studies that were conducted showing the absolute lack of transparency and ability to gather pertinent information from insurance payers' websites.  Some of the worst offenders were not just the Big Blues, but CMS, as well.  From experience, if you've ever tried to find specific information on the CMS website, bring a sack lunch and perhaps order dinner. You'll be there for a while trying to locate what you need.  Hall stated there are ways to streamline processes and could save the insurance industry billions (with a B) of dollars if they just put a little effort in up front.  Personally, I think insurance payers want to continue in this maelstrom of operations to manipulate the entire healthcare industry into thinking it's beyond repair. 

Politics aside, there is an enormous shift coming to our industry.  More and more HSA/HRA accounts are being allowed and set up by employers due to high costs and large employee deductibles.  I see this as the insurance companies working their way out of business.  They keep pushing cost responsibilities back to the patient, and in doing so, are wiping their hands clean of financial responsibility.  I foresee patients foregoing private insurance and just paying out of pocket for all service, since they already are anyway. 

Trying to understand insurance plans, whether you are a patient or a provider is like learning another language.  They aren't straightforward.  I'm in the industry and I had a "surprise!  You have a $150 CO-PAY with your visit today" last month.  Yes, it did say copay, not deductible or co-insurance.  I called my insurance company and asked them why a co-pay, and they said because it was a specialist and didn't you read your plan documentation?" Oh, you mean the postcard that came in the mail that said, "We made changes to our privacy policy?"  I didn't read that because it didn't have anything to do with my personal plan.  Thanks, Aetna for your transparency and customer service.

Get involved with any local legal movements in your area, please continue to learn, read, make yourself aware and put your seatbelt on tight.  This is going to be an "E-Ticket" ride coming up in the next few years as we take back our health.

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