Insurance networks.....BEWARE...corrected email
Jim DeWees
Description
Collection
Title:
Insurance networks.....BEWARE...corrected email
Creator:
Jim DeWees
Date:
5/9/2006
Text:
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.
Later, I spoke with 3 individuals there this afternoon to get a better
understanding of who they are, what they are trying to accomplish. I spoke
to them at this point as a CP, and the owner of a facility. They say they
are a safe arm's distance away from Hanger, although their website clearly
states that they are wholly owned by Hanger. The only facilities in their
network are Hanger facilities, although the website states that there are
also independent facilities that are included. Two of the people I spoke
with state that they are in the process of starting to collect information
on independent facilities and will at some point be expanding their list of
providers.
But, in the meantime, they have already made connections with insurance
companies (like Cigna that is scheduled to go online here shortly...so if
you are a Cigna contracted provider today, that will soon be all referred to
a Hanger facility because they will be the administrators for Cigna, as I
understand it) and they will continue to try to capture as many insurance
companies as possible and will then self-refer the patients in these
networks to their own facilities....oops, I mean the Hanger facilities,
since they are not really connected, or at least an arm's distance away.
Also, if any independent facilities want to be in the network, it will
either be based on a discounted contract with them, meaning that Linkia will
get a cut of the money from the claims, or they will charge a monthly
membership fee, which again, will give them a cut of the claims as well.
Either way, all the independent facilities that want to participate in the
Linkia network will one way or another, be adding to the stock value of
Hanger on the market. We will have to support and pay our competitor in one
way or another.
This is great set up for them. Ingenious.
I also received an email from Medicare last week about the Competitive
Bidding issue coming up again. It is very plain as to what the plans are
for Medicare to control their spending and the costs. It is basically set
up to pay all of us the lowest amount that we are contracted with whatever
company, and the average real price of the procedure codes for orthotics
and prosthetics. I have said this for years, that it won't take medicare
too long to realize that if we can make a leg for, let's say, a GM patient
and get paid about 35% below medicare allowable, and we accept that and
don't do anything to fight that fee schedule, the Medicare is obviously
paying WAY TOO MUCH for the same exact leg for a different patient. When an
Anthem patient walks out the door with a new leg, I also expect to get paid
a lot less than Medicare as well, but I would guess that Anthem finally
figured that they could match the Blue Cross Blue Shield of Michigan, which
is who pays for GM patients, but those claims are processed by a company
called Northwood (many of you know about this company and have dealt with
them). The interesting thing about Northwood, and the lowball prices that
they pay, is that the owner of this company is a CPO and is on the board of
directors for AOPA.
Other members of the board of directors for AOPA, and leaders of ABC and all
our governing bodies are deeply involved with Hanger or the executives of
Hanger.
Many of these people also were the ones that were on the NegReg committee,
that we have all heard about that failed so miserably. I wonder why.
Now these organizations have announced that they will be joining in some
unity to go again and fight a battle, under a new name, a new committee, or
whatever you want to call it. Will this one work? I guess we will see. I
guess what will matter the most on whether it is successful or not is by how
much the decisions will affect there personal interests.
Back to the main point, we all need to keep an eye out on what Linkia is up
to, and what they are truly all about. As I stated earlier, as of now
(which is the same answer I got a year ago) they are only collecting
information about private, or independent O&P providers. They have not
opened up the doors to let anyone other than Hanger facilities in their
network.
Can the ACA get involved in any way? Will they get involved? Can they
educate 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 contract
which will make it cost prohibitive to even try to use the product. There
are several products out there today that many amputees cannot get because
of insurance caps and low paying contracts.
As I stated in the last public posting I did, we are making great strides to
keep the PTs out of this field, we will successfully make it so that nobody
can make a living at doing O&P. Maybe the only way that an amputee in the
future can get a leg, is because the PT can use the CPT codes and bill for
the time that he/she spent with the patient, maybe they can also get paid
for fabrication time and fitting time, and everything else. Maybe that will
be the our just reward for trying to outbid each other. And since that
tactic has not worked to put each other out of business (which is kind of my
perception of some of these tactics), now some of us in the industry are
creating (or have created) insurance administration companies that are the
new way of limiting who can be involved and who cannot, which does not
reflect anything about credentials, qualifications, or anything else. It is
just a matter of who you are connected with.
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.
The number to call and ask the question of where a patient can go is:
1-877-754-6542 and then hit 0 for the operator.
To ask about how to get in the network, dial the same number, then push the
# key and type in HARRIS and you will get Monica Harris, who is the one
gathering information on who is interested in becoming a provider.
There are other numbers on their website to call and voice your complaint or
concerns.
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
>To unsubscribe, send a message to: <Email Address Redacted> with
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>
>Public commercial postings are forbidden. Responses to inquiries
>should not be sent to the entire oandp-l list. Professional credentials
>or affiliations should be used in all communications.
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.
Later, I spoke with 3 individuals there this afternoon to get a better
understanding of who they are, what they are trying to accomplish. I spoke
to them at this point as a CP, and the owner of a facility. They say they
are a safe arm's distance away from Hanger, although their website clearly
states that they are wholly owned by Hanger. The only facilities in their
network are Hanger facilities, although the website states that there are
also independent facilities that are included. Two of the people I spoke
with state that they are in the process of starting to collect information
on independent facilities and will at some point be expanding their list of
providers.
But, in the meantime, they have already made connections with insurance
companies (like Cigna that is scheduled to go online here shortly...so if
you are a Cigna contracted provider today, that will soon be all referred to
a Hanger facility because they will be the administrators for Cigna, as I
understand it) and they will continue to try to capture as many insurance
companies as possible and will then self-refer the patients in these
networks to their own facilities....oops, I mean the Hanger facilities,
since they are not really connected, or at least an arm's distance away.
Also, if any independent facilities want to be in the network, it will
either be based on a discounted contract with them, meaning that Linkia will
get a cut of the money from the claims, or they will charge a monthly
membership fee, which again, will give them a cut of the claims as well.
Either way, all the independent facilities that want to participate in the
Linkia network will one way or another, be adding to the stock value of
Hanger on the market. We will have to support and pay our competitor in one
way or another.
This is great set up for them. Ingenious.
I also received an email from Medicare last week about the Competitive
Bidding issue coming up again. It is very plain as to what the plans are
for Medicare to control their spending and the costs. It is basically set
up to pay all of us the lowest amount that we are contracted with whatever
company, and the average real price of the procedure codes for orthotics
and prosthetics. I have said this for years, that it won't take medicare
too long to realize that if we can make a leg for, let's say, a GM patient
and get paid about 35% below medicare allowable, and we accept that and
don't do anything to fight that fee schedule, the Medicare is obviously
paying WAY TOO MUCH for the same exact leg for a different patient. When an
Anthem patient walks out the door with a new leg, I also expect to get paid
a lot less than Medicare as well, but I would guess that Anthem finally
figured that they could match the Blue Cross Blue Shield of Michigan, which
is who pays for GM patients, but those claims are processed by a company
called Northwood (many of you know about this company and have dealt with
them). The interesting thing about Northwood, and the lowball prices that
they pay, is that the owner of this company is a CPO and is on the board of
directors for AOPA.
Other members of the board of directors for AOPA, and leaders of ABC and all
our governing bodies are deeply involved with Hanger or the executives of
Hanger.
Many of these people also were the ones that were on the NegReg committee,
that we have all heard about that failed so miserably. I wonder why.
Now these organizations have announced that they will be joining in some
unity to go again and fight a battle, under a new name, a new committee, or
whatever you want to call it. Will this one work? I guess we will see. I
guess what will matter the most on whether it is successful or not is by how
much the decisions will affect there personal interests.
Back to the main point, we all need to keep an eye out on what Linkia is up
to, and what they are truly all about. As I stated earlier, as of now
(which is the same answer I got a year ago) they are only collecting
information about private, or independent O&P providers. They have not
opened up the doors to let anyone other than Hanger facilities in their
network.
Can the ACA get involved in any way? Will they get involved? Can they
educate 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 contract
which will make it cost prohibitive to even try to use the product. There
are several products out there today that many amputees cannot get because
of insurance caps and low paying contracts.
As I stated in the last public posting I did, we are making great strides to
keep the PTs out of this field, we will successfully make it so that nobody
can make a living at doing O&P. Maybe the only way that an amputee in the
future can get a leg, is because the PT can use the CPT codes and bill for
the time that he/she spent with the patient, maybe they can also get paid
for fabrication time and fitting time, and everything else. Maybe that will
be the our just reward for trying to outbid each other. And since that
tactic has not worked to put each other out of business (which is kind of my
perception of some of these tactics), now some of us in the industry are
creating (or have created) insurance administration companies that are the
new way of limiting who can be involved and who cannot, which does not
reflect anything about credentials, qualifications, or anything else. It is
just a matter of who you are connected with.
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.
The number to call and ask the question of where a patient can go is:
1-877-754-6542 and then hit 0 for the operator.
To ask about how to get in the network, dial the same number, then push the
# key and type in HARRIS and you will get Monica Harris, who is the one
gathering information on who is interested in becoming a provider.
There are other numbers on their website to call and voice your complaint or
concerns.
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
>To unsubscribe, send a message to: <Email Address Redacted> with
>the words UNSUB OANDP-L in the body of the
>message.
>
>If you have a problem unsubscribing,or have other
>questions, send e-mail to the moderator
>Paul E. Prusakowski,CPO at <Email Address Redacted>
>
>OANDP-L is a forum for the discussion of topics
>related to Orthotics and Prosthetics.
>
>Public commercial postings are forbidden. Responses to inquiries
>should not be sent to the entire oandp-l list. Professional credentials
>or affiliations should be used in all communications.
Citation
Jim DeWees, “Insurance networks.....BEWARE...corrected email,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/226490.
