Medicaid Advantage Plans
RANDY LOYA
Description
Collection
Title:
Medicaid Advantage Plans
Creator:
RANDY LOYA
Date:
5/30/2019
Text:
We recently had a Medicaid Managed Care Program send us a contract
amendment. They used to compensate based on 100% of Texas Medicaid and now
will only compensate at a lower percentage of the Medicaid fee schedule.
In our state Medicaid has the lowest reimbursement rates by far and they
are asking us to accept way less than that. I realize we have the ability
to deny this amendment or terminate the contract but we are in a rural area
and actually care about our patients. I have negotiated two increases in
their reimbursements but it is still considerably lower than any other
rates and in most cases well below our cost.
1. Has anyone else had that issue with respect to the Advantage plans?
What was your recourse?
2. How low is too low and at what point do we choose money over patient
care?
3. Does it seem like the insurance companies hold all the cards?
Randy Loya, LAT, COF, COA
Operations Manager/ Practitioner
Central Texas Orthotics & Prosthetics, LP
*Helping people regain their independence one step at a time...*
amendment. They used to compensate based on 100% of Texas Medicaid and now
will only compensate at a lower percentage of the Medicaid fee schedule.
In our state Medicaid has the lowest reimbursement rates by far and they
are asking us to accept way less than that. I realize we have the ability
to deny this amendment or terminate the contract but we are in a rural area
and actually care about our patients. I have negotiated two increases in
their reimbursements but it is still considerably lower than any other
rates and in most cases well below our cost.
1. Has anyone else had that issue with respect to the Advantage plans?
What was your recourse?
2. How low is too low and at what point do we choose money over patient
care?
3. Does it seem like the insurance companies hold all the cards?
Randy Loya, LAT, COF, COA
Operations Manager/ Practitioner
Central Texas Orthotics & Prosthetics, LP
*Helping people regain their independence one step at a time...*
Citation
RANDY LOYA, “Medicaid Advantage Plans,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/209595.
