Re: "Continuation of Care" Request may be answer for some to CIGNA/LINKIA limitations
Wil Haines
Description
Collection
Title:
Re: "Continuation of Care" Request may be answer for some to CIGNA/LINKIA limitations
Creator:
Wil Haines
Date:
9/28/2006
Text:
Continuation of care seems like a slick way for Cigna to sidestep the
complaints from their decision and play right into the hand of Hanger
inasmuch that no new work will be coming through the door. Continuation
of care should read Choice of Care.
While I am at it, there seem to be other problems with this picture
inasmuch that Hanger owns Linkia. Who will control what reimbursement
rates are established for each independent provider and for each Hanger
provider? Does anyone think there will be fairness with this? Or, is the
Linkia processing (administrative) fee high enough to cover Hanger's loss
of revenue from deep discounted O&P services and provide Linkia with an
attractive bottom line that shores up the P&L statement of Hanger? If so,
then in my opinion, it becomes all about administration and the bottom
line, and little about the health care for which the administrative wing
exists in the first place. I think I knew that was coming anyway. At
least for the past few years, it sure seems that way.
Regarding contracts. Federal law allows for a reasonable profit for
services rendered with any federal contract. If it can be shown that a
reasonable profit is not being made (which I believe is possible) with the
O&P reimbursement rates that are being handed out by Cigna, Anthem, and
other health carriers, I believe we could at least get the attention of
the federal government. After all, when providers will not or cannot
provide health care services, the costs associated with these services are
frequently shifted to the federal governement, via emergency room
treatments, via Medicaid, etc., etc. In essence, it seems like the trick
these days is for private insurance carriers to shift their costs back to
the federal government, when they can. Smart thinking as long as it will
last.
Wil Haines, CPO/L
>
>
> An email that I just received shares a sad story
> (www.gottrys.com/leggo ... see Industry Response #11), as CO
> shares about a patient who is finally receiving the care she
> deserves is notified that she can no longer continue to see her
> prosthetist.
>
> The good news is that a CIGNA medical manager seemed to be touched
> and concerned, suggesting that she complete a Continuation of
> Care form to continue care by her prosthetist. This is a great
> approach to recommend to all patients who are being forced to
> change providers!
>
> In another letter (www.gottrys.com/leggo ... see Industry Response
> #10), a CPO really hits the bottom line of the interest on the
> part of insurance companies to align with LINKIA/HANGER. In the
> process, I think he called me an adverse selection beneficiary .
> with no offense intended or taken
>
> J
>
> !
>
> The insurance company can limit access to providers, thereby
> causing them to be fed up and seek insurance elsewhere . reducing
> the number of patients who have a high utilization rate and
> improvement their bottom line.
>
> Linkia inevitably is stuck servicing a low paying plan with
> decreasing member enrollment as beneficiaries jump to other
> carriers.
>
> ----------------
> Daniel Gottry
> <Email Address Redacted>
> 480-491-1020
> Visit: www.gottrys.com
>
>
>
complaints from their decision and play right into the hand of Hanger
inasmuch that no new work will be coming through the door. Continuation
of care should read Choice of Care.
While I am at it, there seem to be other problems with this picture
inasmuch that Hanger owns Linkia. Who will control what reimbursement
rates are established for each independent provider and for each Hanger
provider? Does anyone think there will be fairness with this? Or, is the
Linkia processing (administrative) fee high enough to cover Hanger's loss
of revenue from deep discounted O&P services and provide Linkia with an
attractive bottom line that shores up the P&L statement of Hanger? If so,
then in my opinion, it becomes all about administration and the bottom
line, and little about the health care for which the administrative wing
exists in the first place. I think I knew that was coming anyway. At
least for the past few years, it sure seems that way.
Regarding contracts. Federal law allows for a reasonable profit for
services rendered with any federal contract. If it can be shown that a
reasonable profit is not being made (which I believe is possible) with the
O&P reimbursement rates that are being handed out by Cigna, Anthem, and
other health carriers, I believe we could at least get the attention of
the federal government. After all, when providers will not or cannot
provide health care services, the costs associated with these services are
frequently shifted to the federal governement, via emergency room
treatments, via Medicaid, etc., etc. In essence, it seems like the trick
these days is for private insurance carriers to shift their costs back to
the federal government, when they can. Smart thinking as long as it will
last.
Wil Haines, CPO/L
>
>
> An email that I just received shares a sad story
> (www.gottrys.com/leggo ... see Industry Response #11), as CO
> shares about a patient who is finally receiving the care she
> deserves is notified that she can no longer continue to see her
> prosthetist.
>
> The good news is that a CIGNA medical manager seemed to be touched
> and concerned, suggesting that she complete a Continuation of
> Care form to continue care by her prosthetist. This is a great
> approach to recommend to all patients who are being forced to
> change providers!
>
> In another letter (www.gottrys.com/leggo ... see Industry Response
> #10), a CPO really hits the bottom line of the interest on the
> part of insurance companies to align with LINKIA/HANGER. In the
> process, I think he called me an adverse selection beneficiary .
> with no offense intended or taken
>
> J
>
> !
>
> The insurance company can limit access to providers, thereby
> causing them to be fed up and seek insurance elsewhere . reducing
> the number of patients who have a high utilization rate and
> improvement their bottom line.
>
> Linkia inevitably is stuck servicing a low paying plan with
> decreasing member enrollment as beneficiaries jump to other
> carriers.
>
> ----------------
> Daniel Gottry
> <Email Address Redacted>
> 480-491-1020
> Visit: www.gottrys.com
>
>
>
Citation
Wil Haines, “Re: "Continuation of Care" Request may be answer for some to CIGNA/LINKIA limitations,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 21, 2024, https://library.drfop.org/items/show/227189.
