Re: Insurance networks.....BEWARE...corrected email
David DeLuccia, LPO, CPO
Description
Collection
Title:
Re: Insurance networks.....BEWARE...corrected email
Creator:
David DeLuccia, LPO, CPO
Date:
5/12/2006
Text:
Paul please post this response to the entire listserve as a response to
Jim Dewees' post
Thanks Jim for the strong points!
I have come up with what I consider to be an ingenious business plan.
Let me run it by you.
I am a large health care provider who is publicly traded. I have been
fairly unsuccessful in competing with smaller, privately owned and
better-run competitors. I must produce profits and growth to satisfy my
shareholders and provide stock perks for upper management. My
professional staff is bonused by the amount of profit their individual
offices generate. I decide to accept insurance contracts that are
literally below cost. I make up for the loss by creating my own third
party administrator who charges a management fee to the same insurance
companies. This fee provides increased revenue to offset the initial
write-down. This also lowers the profits at individual centers allowing
me to pocket the money that I would have otherwise paid to my
professional staff in bonuses. This makes the company more profitable
to investors and the stock price goes up.
Now, I realize that I will begin to lose senior professional staff, but
that is really no worry, as I own my own school and I can cherry pick
the young graduates and place them in my numerous offices. Oh, by the
way, these young graduates are willing to work for less money thereby,
once again enhancing the bottom line!
Wow, I wonder why no one else has thought of this?
It's amazing to me as a young professional in O&P that owners of
independent O&P facilities cannot join together and force change not
only in insurance coverage (programs) but also in manufacturer
discounts. The old boys club mentality (being a loner) will ensure the
field never
progresses past experienced educated practitioners just being hammer
swingers. Every profession has a unified agenda except, evidently,
ours. Wouldn't it be
nice to put our buying power together for pricing discounts and/or
insurance
contracting? It would seem to me that we should have 66% of the buying
power in the industry. I've heard that only 33% could bring large
discounts (that's only 1/2 of us). Again, I wish someone could dream
up a plan (or network) like this.....Wait there is and it even has a
name OPGA/POINT. They do all of these things and only need the support
of independents. Why can't we make this successful???
Thanks for your attention...Please help to make a change before all
orthotists/prosthetists suffer...Yes, you too can help make a
difference!
In hopes that I can continue to profitably do the job I love,
David DeLuccia, CPO,LPO
----- Original Message -----
> I have been busy today (in my spare time) trying to find out more
> about a
> wonderful new insurance network that has been created to improve
> the quality
> of O&P services, making it more easy for amputees and referral
> sources to
> find qualified, competent care.
>
> The network is: LINKIA>
> We should all be very concerned with what is going on with this
> network. In
> fact, I called them today to ask where I can find a qualified
> prosthetist to
> make me a new leg (I am in fact a BK amputee) and gave them my zip
> code, and
> guess who they have to recommend for me? Hanger of course...
...
> Can the ACA get involved in any way? Will they get involved? Can
> theyeducate the amputees in what is really going on with this
> field? Should
> they be involved in this manner, is that kind of included in their
> mission?
> If we keep on the track we are going, this field is going to
> collapse, we
> won't be able to provide any prosthetic care because before long,
> we will be
> getting paid less than the wholesale cost of the components.
>
> I found it very interesting when last week someone posted the article
> talking about this new prosthetic arm and hand that is more
> responsive, can
> give sensory feedback, and what that will offer the upper extremity
> amputees. I think that could be exciting if they can get
> something like
> that to actually come to pass. But, even with it being available
> and even
> if it is proven to be a benefit to the amputee, who will pay for
> that. I
> cannot see Anthem paying anything for such a device. If they did
> pay for
> it, someone in this field will go and make a bid for a low-ball
> contractwhich will make it cost prohibitive to even try to use the
> product. There
> are several products out there today that many amputees cannot get
> becauseof insurance caps and low paying contracts.
>
...
> So, I guess we will see how this new concept of Linkia will change the
> industry, if it will improve access and quality of care. I have
> my serious
> doubts and issues with this idea. It is a major conflict of
> interest at the
> very least, and all of us out here will probably feel the effects
> of it to
> some degree. And, more importantly, the patients that need this
> care are
> going to definitely feel the effects of this big money making
> scheme of
> Hanger.
>
> Well, now we can see who is putting the pinch on us the most, the
> government, the PTs, or our very own colleagues, and the very
> directors of
> the governing agencies of the O&P world. And the worst part about
> that is
> that we are paying membership fees, dues, etc. to these people
> that turn
> right around and stick it to us even harder.
>
> Just my thoughts and issues that I have with this.
>
> I encourage each and every one of you to call Linkia, or have a
> patient call
> Linkia and have them ask who they could go to for good qualified
> care in
> your area. See for yourself who Linkia is referring the patients
> to. In my
> case, there are 2 providers that are within 5 miles of the zip
> code that I
> asked about. The closest facility that they recommended is 50
> miles away.
> That is sure looking out for patient, make them drive 10 times
> farther than
> necessary. But of course Linkia doesn't know about me, only Hanger.
>
> Also, call Linkia as a practitioner and ask how you can get on
> their list
> and what it will cost you. You cannot get on the list, it does
> not exist
> yet. The company is over 2 years old, and they still have not
> formed a
> list? But, they have managed to secure some insurance companies.
>
> We need to stand up to this kind of activity and show our concerns
> and find
> out why they are doing this, what they intend to accomplish with this.
>
> Jim DeWees, CP
Jim Dewees' post
Thanks Jim for the strong points!
I have come up with what I consider to be an ingenious business plan.
Let me run it by you.
I am a large health care provider who is publicly traded. I have been
fairly unsuccessful in competing with smaller, privately owned and
better-run competitors. I must produce profits and growth to satisfy my
shareholders and provide stock perks for upper management. My
professional staff is bonused by the amount of profit their individual
offices generate. I decide to accept insurance contracts that are
literally below cost. I make up for the loss by creating my own third
party administrator who charges a management fee to the same insurance
companies. This fee provides increased revenue to offset the initial
write-down. This also lowers the profits at individual centers allowing
me to pocket the money that I would have otherwise paid to my
professional staff in bonuses. This makes the company more profitable
to investors and the stock price goes up.
Now, I realize that I will begin to lose senior professional staff, but
that is really no worry, as I own my own school and I can cherry pick
the young graduates and place them in my numerous offices. Oh, by the
way, these young graduates are willing to work for less money thereby,
once again enhancing the bottom line!
Wow, I wonder why no one else has thought of this?
It's amazing to me as a young professional in O&P that owners of
independent O&P facilities cannot join together and force change not
only in insurance coverage (programs) but also in manufacturer
discounts. The old boys club mentality (being a loner) will ensure the
field never
progresses past experienced educated practitioners just being hammer
swingers. Every profession has a unified agenda except, evidently,
ours. Wouldn't it be
nice to put our buying power together for pricing discounts and/or
insurance
contracting? It would seem to me that we should have 66% of the buying
power in the industry. I've heard that only 33% could bring large
discounts (that's only 1/2 of us). Again, I wish someone could dream
up a plan (or network) like this.....Wait there is and it even has a
name OPGA/POINT. They do all of these things and only need the support
of independents. Why can't we make this successful???
Thanks for your attention...Please help to make a change before all
orthotists/prosthetists suffer...Yes, you too can help make a
difference!
In hopes that I can continue to profitably do the job I love,
David DeLuccia, CPO,LPO
----- Original Message -----
> I have been busy today (in my spare time) trying to find out more
> about a
> wonderful new insurance network that has been created to improve
> the quality
> of O&P services, making it more easy for amputees and referral
> sources to
> find qualified, competent care.
>
> The network is: LINKIA>
> We should all be very concerned with what is going on with this
> network. In
> fact, I called them today to ask where I can find a qualified
> prosthetist to
> make me a new leg (I am in fact a BK amputee) and gave them my zip
> code, and
> guess who they have to recommend for me? Hanger of course...
...
> Can the ACA get involved in any way? Will they get involved? Can
> theyeducate the amputees in what is really going on with this
> field? Should
> they be involved in this manner, is that kind of included in their
> mission?
> If we keep on the track we are going, this field is going to
> collapse, we
> won't be able to provide any prosthetic care because before long,
> we will be
> getting paid less than the wholesale cost of the components.
>
> I found it very interesting when last week someone posted the article
> talking about this new prosthetic arm and hand that is more
> responsive, can
> give sensory feedback, and what that will offer the upper extremity
> amputees. I think that could be exciting if they can get
> something like
> that to actually come to pass. But, even with it being available
> and even
> if it is proven to be a benefit to the amputee, who will pay for
> that. I
> cannot see Anthem paying anything for such a device. If they did
> pay for
> it, someone in this field will go and make a bid for a low-ball
> contractwhich will make it cost prohibitive to even try to use the
> product. There
> are several products out there today that many amputees cannot get
> becauseof insurance caps and low paying contracts.
>
...
> So, I guess we will see how this new concept of Linkia will change the
> industry, if it will improve access and quality of care. I have
> my serious
> doubts and issues with this idea. It is a major conflict of
> interest at the
> very least, and all of us out here will probably feel the effects
> of it to
> some degree. And, more importantly, the patients that need this
> care are
> going to definitely feel the effects of this big money making
> scheme of
> Hanger.
>
> Well, now we can see who is putting the pinch on us the most, the
> government, the PTs, or our very own colleagues, and the very
> directors of
> the governing agencies of the O&P world. And the worst part about
> that is
> that we are paying membership fees, dues, etc. to these people
> that turn
> right around and stick it to us even harder.
>
> Just my thoughts and issues that I have with this.
>
> I encourage each and every one of you to call Linkia, or have a
> patient call
> Linkia and have them ask who they could go to for good qualified
> care in
> your area. See for yourself who Linkia is referring the patients
> to. In my
> case, there are 2 providers that are within 5 miles of the zip
> code that I
> asked about. The closest facility that they recommended is 50
> miles away.
> That is sure looking out for patient, make them drive 10 times
> farther than
> necessary. But of course Linkia doesn't know about me, only Hanger.
>
> Also, call Linkia as a practitioner and ask how you can get on
> their list
> and what it will cost you. You cannot get on the list, it does
> not exist
> yet. The company is over 2 years old, and they still have not
> formed a
> list? But, they have managed to secure some insurance companies.
>
> We need to stand up to this kind of activity and show our concerns
> and find
> out why they are doing this, what they intend to accomplish with this.
>
> Jim DeWees, CP
Citation
David DeLuccia, LPO, CPO, “Re: Insurance networks.....BEWARE...corrected email,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/226488.
