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Deleted by topic administrator 04-30-2010 08:04 AM
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Poor PT
03-10-2010
01:36 AM ET (US)
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Seems we are not getting an eval fee in addition to lower reimbursement for the treatment. I was actually hoping WE would feel better after the initial visit, too!!!
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MCPT
03-09-2010
08:31 PM ET (US)
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Seems that way, but does anyone know what the current fee schedule is? I decided not to sign the contract, so I don't know. The contract did say $75 or less per visit regardless of intensity. Said nothing about a premium for an eval or re-eval. So who knows, however it would probably will be a loss either way. Especially if your client would like to feel better after the initial visit.
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Poorboy PT
03-09-2010
01:08 AM ET (US)
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Does anyone know how in network BC providers will be reimbursed for an evaluation? Seems there will be no financial benefit to providing a treatment with evaluation if they are reimbursed at $75 for both combined?
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Standing Firm
03-04-2010
08:29 PM ET (US)
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Does this mean that if we (i.e. the provider) are NOT contracted with BC, that we CAN bill the patient for the 20%? This is how we suspect it should be, since we have no agreement with BC. But we're not sure if there are Medicare restrictions on such things.
Thanks for the help - -
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Lorrie Bosick-PTM Systems
03-04-2010
02:55 PM ET (US)
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The way I see it, Anthem will not pay any of the 80% allowed by Medicare under terms of Indemnity or Supplimental type plans. Under Indemnity type plans Anthem will not cover anything if Anthem allows less than Medicare. This will most likely be the case. Indemnity plans allow 80 percent minus what Medicare paid. Since Anthem allows less they would pay nothing. If Anthem were a supplimental they should pay the 20 percent owed. The key work is should. In the indemnity plan case the provider will not be able to bill the patient if contracted as the provider agreed to the contract rate allowed by Blue Cross which is less than Medicare. I hope my message is clear and thanks for allowing me to chime in.
Lorrie Bosick-Practice Management Advisor
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Standing Firm
03-04-2010
02:25 PM ET (US)
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Rick - in your message,(# 141) - which "they" are you referring to - Anthem or the patient?? The "they"'s in the first two sentences of this message are what are puzzling to me. f Anthem does not pick up any of the difference between M/C's allowable and the 80% that M/C pays, can we hold the patient responsible for it??
Thanks -
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Lorrie Bosick-PTM Systems
03-04-2010
12:52 PM ET (US)
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Usually the way it works is like UHC if they allow less than Medicare on plan such as the Indemnity plan than nothing is paid. You see this type of plan as retirement benefits for companies such as At&T. They create a fee schedule that is less than what Medicare allows and pay nothing. The patient doesn't understand why their secondary picks up nothing on the balance. If it is a true supplement they should pay the 20 percent based on the Medicare fee schedule. I hope this helps.
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Rick
03-04-2010
12:37 PM ET (US)
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To clarify the Medicare issue- If a patient has a Medicare supplemental policy through Anthem they should pick up the difference between what Anthem pays and what Medicare authorizes. If a patient is using Anthem as a Supplemental policy to Medicare then they will pay the difference between the $75 and the Medicare allowable including the copay and deductible if their policy has that benefit. If a patient has Anthem as a Secondary policy (through a spouse or just as an additional insurance) Anthem will not pay anything additional to the $75 but may pick up the 20%.
CPTA is trying to get confirmation of the network coverage from the Dept of Managed Heathcare. We are not confident of the accuracy of the information provided by Anthem. To date their on-line directory has not been accurate. It was our understanding that the DMHC was holding them responsilbe for this but we haven't seen any evidence of this yet.
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pt4free
03-02-2010
10:31 AM ET (US)
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we need to continue to fight and put the pressure with phone calls and emails to the most influential people listed below: ESPECIALLY the Department of Managed Health Care
People Who have influence over the Ancillary Network’s Contract
** most influential
Blue Cross of California
21555 Oxnard Street, 8B
Woodland Hills, CA 91367
Emails are first.lastname@wellpoint.com ex. vera.jackson@wellpoint.com
**Leslie Margolin, President and General Manager
Phone: 818-234-3131
Fax: 818-234-2344
(Boss of Mike R)
**Mike Ramseier, Vice President of Provider Engagement and Contracting
Phone: 818- 234-5444
Fax: 818-234-4340
(Decision Maker-his name is on the contract)
Aldo Delatorre, Regional VP State Contracting (works under Mike)
Aldo.delatorre@wellpoint.com
Nidhi (needy) Jagani, Director of Network Management
Phone:
Fax: 818-234-6301
Vera Jackson, Ancillary Networks and Specialty
Phone: 818-234-2745
Fax: 818-234-6301
Kathleen Brozee, Senior Provider Network Manager
Phone: 818-234-3399
Fax: 818-234-6301
Sharron Fuqua, Regional Director of Provider Contracting
Phone: 818-234-3329
Fax:
State Officials
Honorable Steve Poizner
Insurance Commissioner
California Department of Insurance
300 South Spring Street, South Tower
Los Angeles, CA 90013
***Lucinda “Cindy” Ehnes, Director
California Department of Managed Care
980 9th Street, Suite 500
Sacramento, CA 95814-2725
Email: cehnes@dmhc.ca.gov
**Barbara Reagan
Assistant Deputy Director, California Help Center
California Department of Managed Health Care
980 9th Street, Suite 500
Sacramento CA 95814-2725
Email: breagan@dmhc.ca.gov
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MCPT
03-02-2010
02:08 AM ET (US)
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So what is happening with the network and how long does it take to find out if they are really offering their clients the facilities they require. We are still getting calls from potential patients that tell us that they have called several clinics and that no one is in network with BC. Perhaps that is changing? There was some talk about the insurance commissioner keeping an eye on their "network". I know these things take time, however, this already feels like a century.
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Jennifer
02-26-2010
04:13 PM ET (US)
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6.4 This means that if you take this agreement and a patient has BC as a secondary carrier to Medicare, then they will not owe you anything as the amout you received from Medicare (80% of MC fee schedule) will already equal more than the $75 dollar contract amount.
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Private PT
02-26-2010
10:02 AM ET (US)
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I have to make my decision today whether to opt out. Can anyone tell me specifically where the contract states they will not pay if the Medicare payment exceeds $75?
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Richard Katz
02-26-2010
02:59 AM ET (US)
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CPTA was able to present a brief statement. There was a brief meeting prior to the hearing with the Assembly Health Committee staff where our position was stated. The focus of the hearing was on patient premiums. I would not anticipate that there will be any pressure from the state legislature to force Anthem to reverse their decision on our rates.
< replied-to message removed by QT >
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MCPT
02-25-2010
06:18 PM ET (US)
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Many of us were busy with the demonstration that happened Tuesday mid-day at Anthem BC headquarter in Woodland Hills. It went well and there was media coverage. Our demonstration was tied into articles Wed and today regarding the hearings in Ca. and Washington. Take a look at the Latextra pages Wed and the Business section today. Kabc had some pretty good coverage of our demonstration on air. There was also some coverage in the San Fernando Valley Business Journal. I don't think the hearings have resulted in any changes to BC policy. Perhaps with all the scrutiny there is a chance...
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Standing Firm
02-25-2010
04:18 PM ET (US)
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Anybody know what happened at yesterday's hearings on the BC rate hike? - The CA state hearings, that is - - Edited 02-25-2010 04:18 PM
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