US Politics, follow up on insurance issues.
Jim DeWees
Description
Collection
Title:
US Politics, follow up on insurance issues.
Creator:
Jim DeWees
Date:
7/14/2009
Text:
I want to thank all those that responded to my email about Anthem and Humana Medicare policies. In a way, I am glad to know that I am by far not the only one that has frustrations and major issues with this situation....but I wasn't at all shocked to find that out.
We, as a body of professionals, need to come together in some manner to stand up for our profession and for the work that we do, and ultimately stand up for our patients that depend on us for quality services and devices. We cannot accept these contracting practices of these insurance companies. They are not negotiated contracts, they are take it or leave it situations.
I am not at all saying or implying that we boycott these companies or anything like that. We need to determine what we are willing to accept, and at what point can we continue to keep providing services to patients that have coverage that doesn't even cover the cost of the componentry.
One email (out of dozens) made a comment about this being a strong indicator in favor of a one payer system. I strongly disagree with that view. In my opinion, from what I have experienced and shared here with this group is exactly why a One Payer System will NOT work. It is no secret that Anthem and others are deeply connected with many people in Washington, and even have a lobbyist (Tom Daschle) who was going to be the new Sec of Health and Human Services, until it was made public about how many thousands of dollars he was behind on his taxes....(what would happen to any of us if WE were behind even $10,000 in taxes...we get threatening letters and everything else...but the standards are obviously different for those in power...) and he claimed this tax problem was due to a gift that someone gave him, which was a limo and driver to take him wherever he needed to go. The gift-giver was a major insurance company, who obviously was trying to buy his influence in the DC area.
Can't we all see how the government cannot even handle the health care programs that already exist??? Why is Medicare now being outsourced to Anthem, Humana, UHC, and the others??? It is because they know they are not efficient enough to handle that workload. And then look at the Medicaid programs....at least here in Indiana, they are outsourced to several private sector companies, Anthem being the biggest, and the other Indiana Medicaid (Hoosier Healtwise) is outsourced to Managed Health Services that is located in the St. Louis, MO area, not even in Indiana....sending out tax dollars out of Indiana...that sure seems like a great move for our state. But, they are obviously more efficient and capable of handling the Medicaid claims that our very own government can do.
A ONE PAYER SYSTEM would mean that they would choose some private sector company, or possible several companies just like the Medicare/CMS model, and then turn it back over the them. These companies are really working the system to be in place, to get their big piece of the pie, in a way. Just think if all of the sudden, a company like Anthem was just given several thousand new policy holders, with government money to back that. Then the CEO's bonus check will be a few million dollars more next year....like $58 million bonus isn't enough.....let's just make that a $90 million bonus, most of the being subsidized by our added tax dollars, and then add in our donations to the patients that have Anthem, Humana, or whatever else is in that mix....and then try to figure out what claims go to what payer....do we submit them to the Government, or to Anthem, Humana, or where??? And how many of those will be lost in the process???
It looks like a disaster. I guess we might all have the option of not accepting assignment and have the patients pay up front for things at OUR price, and then let the patients get the wonderful whopping check back to them (which we know will leave them stuck with thousands of dollars that they have to pay out of pocket), but how many of our patients really have that kind of cash sitting around for these things???
The day will come when we will have to resort to doing cash work, if this plan goes through. I sure cannot stay in business if I have to rely on these contracted rates that these companies offer.
Oh yeah, I forgot to mention that in Indiana, we have the best prosthetic parity bill that has ever been passed (according to the article written in the O&P Edge a few months back. It was written and sponsored by Mike Murphy, a state representative, who is also the Pres. of Anthem Blue Cross Blue Shield of Nevada (which is headquartered in Indianapolis, where Mike Murphy lives and works). He wrote the bill to look like he is a friend of the amputees and O&P community, but he filled the bill with provisions giving power to the insurance companies to have negotiated contracts and fees, which was in the sentence following the one that says that insurance companies must pay Medicare allowables.....well, Anthem Medicare isn't even paying Medicare allowables, but are using their own fee schedules.
The last point here is after my last public email to the list, I did get a call from the Anthem Contracting office, and she claimed she was returning my call that I had left with them at some time. I did not leave any message at Anthem in their contracting dept. I don't even know any phone numbers to get in touch with the Contracting. She was concerned about my issues, and was going to research them and get back with me.
I made sure I pointed out to her about how good her own benefits were, and that I would have to make a K-mart or Walmart quality leg for her if she ever needed one. But, the bigger slam is that any offender (convict, prisoner in jail or prison) has better access to higher quality care here in Indiana. The prison systems here pay Medicaid allowables, which are much higher than the Anthem fees. So, the person behind the bars can get better quality devices and components than the guard that is sitting outside the bars, in the free world. So, I hope she is proud of her contracted fees now.
We all need to figure out what we are willing to take, how far are we going to be pushed around. What can we do about it? What are we willing to do about it, or just sit around and complain about it, and yet have no backbone to actually do anything. What are our leaders of our organizations doing about it? Why have we gotten to this point??
Just some food for thought here, and hopefully we can all become more aware and feel a sense of urgency to get involved somehow, whatever way you can do it.
One last thing: one thing we can all do is make sure we file complaints with the state dept of insurance. Almost every state has that dept in their state government. In Indiana you must wait 90 days after the date of service to file the complaint against the insurance company. If you feel like things were unjustly denied, or processed in error, or partial payments, missing codes, or whatever tactic these companies use, whether intentional or due to stupidity or incompetence, it doesn't matter. If you have the documentation, about what was billed, and what was paid, and there are discrepancies, then report that to the State Dept of Insurance. Call that office, ask them if they can accept that complaint, or maybe it needs to come to Indianapolis if it is an Anthem complaint (since this is one of their main offices here).
The State Insurance Dept does look into these complaints, and they do take action on these things. If there are enough complaints based on the same issue, then they can take action against the company.
Please do whatever you can do, and let's try to get them to play fair with us, or a little more fairly anyway.
Thanks for all of the replies, I wish I could compile them and share them, but as I promised, I will not do that.
Jim DeWees, CP
_________________________________________________________________
Lauren found her dream laptop. Find the PC that’s right for you.
<URL Redacted>
We, as a body of professionals, need to come together in some manner to stand up for our profession and for the work that we do, and ultimately stand up for our patients that depend on us for quality services and devices. We cannot accept these contracting practices of these insurance companies. They are not negotiated contracts, they are take it or leave it situations.
I am not at all saying or implying that we boycott these companies or anything like that. We need to determine what we are willing to accept, and at what point can we continue to keep providing services to patients that have coverage that doesn't even cover the cost of the componentry.
One email (out of dozens) made a comment about this being a strong indicator in favor of a one payer system. I strongly disagree with that view. In my opinion, from what I have experienced and shared here with this group is exactly why a One Payer System will NOT work. It is no secret that Anthem and others are deeply connected with many people in Washington, and even have a lobbyist (Tom Daschle) who was going to be the new Sec of Health and Human Services, until it was made public about how many thousands of dollars he was behind on his taxes....(what would happen to any of us if WE were behind even $10,000 in taxes...we get threatening letters and everything else...but the standards are obviously different for those in power...) and he claimed this tax problem was due to a gift that someone gave him, which was a limo and driver to take him wherever he needed to go. The gift-giver was a major insurance company, who obviously was trying to buy his influence in the DC area.
Can't we all see how the government cannot even handle the health care programs that already exist??? Why is Medicare now being outsourced to Anthem, Humana, UHC, and the others??? It is because they know they are not efficient enough to handle that workload. And then look at the Medicaid programs....at least here in Indiana, they are outsourced to several private sector companies, Anthem being the biggest, and the other Indiana Medicaid (Hoosier Healtwise) is outsourced to Managed Health Services that is located in the St. Louis, MO area, not even in Indiana....sending out tax dollars out of Indiana...that sure seems like a great move for our state. But, they are obviously more efficient and capable of handling the Medicaid claims that our very own government can do.
A ONE PAYER SYSTEM would mean that they would choose some private sector company, or possible several companies just like the Medicare/CMS model, and then turn it back over the them. These companies are really working the system to be in place, to get their big piece of the pie, in a way. Just think if all of the sudden, a company like Anthem was just given several thousand new policy holders, with government money to back that. Then the CEO's bonus check will be a few million dollars more next year....like $58 million bonus isn't enough.....let's just make that a $90 million bonus, most of the being subsidized by our added tax dollars, and then add in our donations to the patients that have Anthem, Humana, or whatever else is in that mix....and then try to figure out what claims go to what payer....do we submit them to the Government, or to Anthem, Humana, or where??? And how many of those will be lost in the process???
It looks like a disaster. I guess we might all have the option of not accepting assignment and have the patients pay up front for things at OUR price, and then let the patients get the wonderful whopping check back to them (which we know will leave them stuck with thousands of dollars that they have to pay out of pocket), but how many of our patients really have that kind of cash sitting around for these things???
The day will come when we will have to resort to doing cash work, if this plan goes through. I sure cannot stay in business if I have to rely on these contracted rates that these companies offer.
Oh yeah, I forgot to mention that in Indiana, we have the best prosthetic parity bill that has ever been passed (according to the article written in the O&P Edge a few months back. It was written and sponsored by Mike Murphy, a state representative, who is also the Pres. of Anthem Blue Cross Blue Shield of Nevada (which is headquartered in Indianapolis, where Mike Murphy lives and works). He wrote the bill to look like he is a friend of the amputees and O&P community, but he filled the bill with provisions giving power to the insurance companies to have negotiated contracts and fees, which was in the sentence following the one that says that insurance companies must pay Medicare allowables.....well, Anthem Medicare isn't even paying Medicare allowables, but are using their own fee schedules.
The last point here is after my last public email to the list, I did get a call from the Anthem Contracting office, and she claimed she was returning my call that I had left with them at some time. I did not leave any message at Anthem in their contracting dept. I don't even know any phone numbers to get in touch with the Contracting. She was concerned about my issues, and was going to research them and get back with me.
I made sure I pointed out to her about how good her own benefits were, and that I would have to make a K-mart or Walmart quality leg for her if she ever needed one. But, the bigger slam is that any offender (convict, prisoner in jail or prison) has better access to higher quality care here in Indiana. The prison systems here pay Medicaid allowables, which are much higher than the Anthem fees. So, the person behind the bars can get better quality devices and components than the guard that is sitting outside the bars, in the free world. So, I hope she is proud of her contracted fees now.
We all need to figure out what we are willing to take, how far are we going to be pushed around. What can we do about it? What are we willing to do about it, or just sit around and complain about it, and yet have no backbone to actually do anything. What are our leaders of our organizations doing about it? Why have we gotten to this point??
Just some food for thought here, and hopefully we can all become more aware and feel a sense of urgency to get involved somehow, whatever way you can do it.
One last thing: one thing we can all do is make sure we file complaints with the state dept of insurance. Almost every state has that dept in their state government. In Indiana you must wait 90 days after the date of service to file the complaint against the insurance company. If you feel like things were unjustly denied, or processed in error, or partial payments, missing codes, or whatever tactic these companies use, whether intentional or due to stupidity or incompetence, it doesn't matter. If you have the documentation, about what was billed, and what was paid, and there are discrepancies, then report that to the State Dept of Insurance. Call that office, ask them if they can accept that complaint, or maybe it needs to come to Indianapolis if it is an Anthem complaint (since this is one of their main offices here).
The State Insurance Dept does look into these complaints, and they do take action on these things. If there are enough complaints based on the same issue, then they can take action against the company.
Please do whatever you can do, and let's try to get them to play fair with us, or a little more fairly anyway.
Thanks for all of the replies, I wish I could compile them and share them, but as I promised, I will not do that.
Jim DeWees, CP
_________________________________________________________________
Lauren found her dream laptop. Find the PC that’s right for you.
<URL Redacted>
Citation
Jim DeWees, “US Politics, follow up on insurance issues.,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/230588.
