We Win Insurance Fight #750

Yet another unscripted example of a client successfully fighting the managed care companies for a better fee schedule.  Verbatim:

I just followed your steps–letter to our patients with a
drop-dead date about 5-6 months ahead, encouraged them to call their
benefits people (this plan covers a lot of small unions; it’s really
just a claims priocessor, so getting the union members to protest was
the key), and waited for the call from [MCO] asking what would they
have to do to keep us. I made a proposal, asking for about 130%
Medicare. They initially came back that they couldn’t go that high, but
then proposed 100% of the N. NJ Medicare rates, which, as I said, are
at least 120% of ours. They could have countered with 100% of OUR
Medicare schedule, but, for some reason, they used the NJ one–to our
major advantage.

 

…we are having our front desk person call [the patients] to inform them that we are staying in the plan–and getting them
to schedule their next well visit at the same time.

I love it, especially that last line.  Sure enough, the doc here ran a quick report and confirmed that it’s a 75 percent fee increase and is getting the kids in ASAP.

Big, conglomorate practice?  No.

Professional negotiator? No.

Willingness to say, “No!” to an MCO? Yes.  That’s what it takes.

Good work.

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