Discover and read the best of Twitter Threads about #healthplans

Most recents (7)

1/Here we go again--in the midst of the #COVID19 when @EmergencyDocs are in harms way for all of us, #healthplans @Amerigroup in this case can't help themselves from using illegal diagnosis lists/algos/bots that key off final diagnoses--expressly not allowed by @CMSGov ...
2/ 2 flag both #outofnetwork & in-network claims (is the delay on the latter a cynical attempt 2 force contracting?)--4 chart review to determine #prudentlayperson status or not--if deemed "non-emergent" then a triage fee is paid--& if no records or so they claim then triage fee
3/ BTW--just received the "auto pay" list--it states its effective 5/1/20--& is 64 pages; there are many thousands of #ICD10 codes--& what a surprise that this plan is an @AnthemInc company--the acorn does not fall far from the oak tree--one of the pioneers of illegal diag. lists
Read 4 tweets
@LorenAdler Surely you'll remember CA Medical Association letter 2 the E&C committee last yr--if not, let me refresh your recollection--& where is the evidence that premiums in CA went down over 4 yrs? No one has produced that evidence have they? @CMAdocs cited numerous examples...
@LorenAdler @CMAdocs 2/ of networks & physician Ks being cut, Pt access to care being limited... all of the ills of your simple solution are in full relief there..
Read 7 tweets
1/ Several features of the not yet passed #COVID19 “3.0” bill (The CARES Act), pluses/ minuses—

1. -2% ⁦@CMSGov⁩ “Medicare sequester cuts” eliminated for duration of public health emergency (PHE)—ok thanks but could we get a complete elimination?
2. Extended ..

2/ ACA enrollment for uninsured in the federal exchanges;

3. Extension of 1.0 GPCI floor through 11/30/20— thx but why the cut off?

4. Feds covering Pt cost sharing for MCA, Advantage & MCD testing & treatment;


1. Both a “Sense of Congress” & Senate language....
3/ that would address #surprisemedicalbilling — what’s a sense of Congress you ask? No clue. Strength of statue? “Strength” of a UN resolution”? Not good if Congress punts entire issue to @HHSGov
Still reviewing Senate language—but are they frigging kidding us w/ cramming...
Read 6 tweets
Let’s parse what the #healthplans are saying & not saying—1. Admin. statements last week that the plans are waiving Pt cost sharing for “treatment” are not clear at best...Insurers Widen Coverage For Coronavirus Screenings To Office Visits via @Forbes…
2/ 2. Plans have said that they will waive cost sharing for #COVID19 testing; 3. Unprecedented in my experience, CPT editorial panel approved last Friday night in an emergency meeting CPT 87635—infectious agent detection by nucleic acid [RNA, DNA] acut respiratory syndrome...
3/ 3. Coronavirus 2, amplified syndrome technique (reimbursement by MCA $31-56) is the code for testing; 4. Aside from possibly @Cigna (in the office POS) the other health plans are waiving cost sharing for this CPT, not for treatment of cough, fever and related HPIs or R/Os...
Read 7 tweets
When #NJ enacted 1 of the worst in the USA #suprisemedicalbilling laws (Aug. '18), #healthplans did the following: 1. @HorizonBCBS said Sept. '18 "reasonable reimbursement" as 110% of CMS as that is what the law required; 2. no meaningful access to #IDR...…
2/ b/c the statute provides no IDR unless the delta between the #physician charges & initial payment is $1K or >; 3. @UHC begins terminating long standing #physician participation Ks to redirect Pts. to clinics owned by their other subsidiary; 4. physician groups are now suing...
@UHC 5/ so 1 could cynically conclude that by benchmarking physician $ to CMS rates, eliminating Ks that are fair coverage & laws w/ no meaningful & accessible dispute resolution results in those very physician groups potentially having to sell out & leading to > vertical integration.
Read 3 tweets
Once again the media gets it wrong w/ their "apples to oranges" comparison of Physicians for Fair Coverage to "Drs. for Pt. Unity--the former's board & staff are clearly ID'd the latter's isn't--Push to Preserve Surprise Medical Billing… via @thedailybeast
@thedailybeast Moreover @NoSurpriseGap has from the start advocated to remove Pts from reimbursement disputes w/ #healthplans --again the author fails to point this out while quoting the highly suspect "unnamed Congressional aid" who appears to be questioning PFC's motives--where were they 5+
@thedailybeast @NoSurpriseGap yrs. ago when the @EmergencyDocs & @EDPMA were proposing model legislation that removed the Pt from the disputes--they are entitled to their own opinions but not entitled to their own facts--that message for "The Daily Beast" isn't as lurid as the "mysterious" Drs. for Pt unity
Read 3 tweets
@HouseCommerce (Chair Pallone/ Ranking Widen) released #NoSurprisesAct 7/9/19 & #healthplans could not happier: 1. Median contracted rates pegged to ‘19 initially as benchmark—watch out below for the low ball offers this yr; 2. Benchmark adjusted for CPI-U (thx? For what?) ....
(2) Pt cost sharing is this weird form of federalism—the lesser of what the Pt would pay under state law, e.g. CA (125% of CMS) or calculated on median K rates (did I say the health plans are still on a bender from last night over this bill?); 3. 1 of the broadest bans on #OON ..
(3) OON ban includes ED care + any facility care if faculty is In Network services + if there’s no par provider & if the service was the result of unforeseen medical needs + Pt consent & cost estimate for OON service must be 72 hours pre service; does not apply to ERISA plans ...
Read 5 tweets

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