|
April 6, 2009
|
|
IN
THIS ISSUE
Editor's Column:
Why We Need Government
In My Opinion: Health Care: Philosophy
Versus Policy
Task Force Against Violence Open House
April 13
Fifth Annual James C. Hazlett, Jr.
Memorial Golf Outing
Health Authority Organizes Free Sports
Physicals, Well Child Care
Cigna Claims Crunch Begins April 20
WellPoint Targeted In Physician Class
Action Lawsuit
AMA to Senate: Make Health Insurer
Payments More Transparent
|
|
Click
Here To Contact Us
|
Editor's
Column: Why We Need Government
(Editor's Note: The last three items in this newsletter
relate somewhat directly to the points raised in this
column and evidence what appears to be a growing problem.)
By
JOSEPH WEISS, MDLikely most physicians are aware of the lawsuit filed in
January by the New York State Attorney General against
United Health Care and its subsidiary Ingenix. The basis
of the suit was that United Health Care had set up Ingenix
as a front to create an artificially low data base of customary
medical fees. The purpose of the rigged data was to underpay
doctors and force higher bills on patients who went to
out-of -network physicians.
This rigged system existed for years until the New York Attorney
General, following the complaints of New York state residents,
found that Ingenix set an out-of-network physician visit
as averaging $67. Patients in United Health Care, or other
insurers such as Aetna who used Ingenix, were told that
the insurance companies would pay 70 percent ($48) but
the rest of the bill was the patient’s responsibility.
The New York Attorney General’s investigation found that
$150 was the true average out-of-network fee, and that
patients insured by United Health, and Aetna should have
received $105, and paid out-of-pocket only $45. Until the
New York State Attorney General stepped in, patients received
only $48 and paid $102 out-of-pocket. A by-product of the
Ingenix scheme was that out-of-network physicians were
made to look greedy as their $150 charge seemed unreasonable
compared to the $67 that Ingenix reported as the usual
and customary fee.
In the settlement of the Ingenix case, United Health paid
a fine of $350 million, and Aetna is in court trying to
avoid a similar fine for acting in collusion with United
Health Care in establishing the bogus pricing.
The Ingenix case illustrates one role of government in health
care: to act as an opposing force to excesses in the marketplace.
United Health Care’s scheme was exposed only because of
a government investigation and stopped because of government
intervention. Government stepped in to restore a fair marketplace.
Few would argue that government alone, without a marketplace,
creates an ineffectual economy. However, those who call
for an end to government in health care need to tell us
who else will prevent and correct corruption in the marketplace.
Share
Your Thoughts on this Article
Back
to top
|
In
My Opinion: Health Care: Philosophy Versus Policy
By
ALLAN DOBZYNIAK, MD
What is the difference between controlling human (physician) behavior
by central edict or controlling human (physician) behavior by economic
disincentives? Either way, physicians have lost their freedom and
free markets have been ravaged. Physicians can no longer function
except by accommodation with government.
The
claim is that these decisions pertaining to government-managed,
universal health care are made because they are moral and
produce the greatest good for the greatest number. I am
unaware of the issuance of a patent on morality or that
its definition has yet to be fixed in stone. We can only
hope the decisions are not driven by utopianism and idealism
that is really a wacko visionary plan for the betterment
of mankind. A presumption of moral superiority eliminates
boundaries in what will not be done in pursuit of “good.” Sometimes
the questions are more important than the answers, or we
risk being manipulated as we are marched through a labyrinth
of deception.
Let
us hope that freedom will not become an enshrined illusion.
If I remember my history, such systems have only been vivid
examples of past failures.
Remember,
it can’t be ordered if it is not on the menu.
Share
Your Thoughts on this Article
Back
to top
|
Task
Force Against Violence Open House April 13
Wayne
County Task Force Against Violence Open House
April 13 - Noon-2 p.m.
Lunch Provided
WCMSSM Headquarters
New Center One Building
3031 W. Grand Blvd., Suite 645
Detroit, MI 48202
Please RSVP by April 10, 2009
Peggy Mitchell
(313) 874-1360 ext 10
pmitchell@msms.org
Share
Your Thoughts on this Article
Back
to top
|
Fifth
Annual James C. Hazlett, Jr. Memorial Golf Outing
Spots are filling up! Register
online @
http://www.golfdigestplanner.com/11468-HazlettMemorialGolfOuting
Payment and registration can also be dropped off at Student Affairs
The 5th Annual James C. Hazlett, Jr.
Memorial Golf Outing
Bringing together students, faculty, alumni, and friends
of Wayne State University School of Medicine
Saturday, May 2, 2009
Twin Lakes Golf and Swim Club
455 Twin Lakes Drive
Oakland Township, MI 48363
Come out for the awesome golf, tasty dinner buffet,
and prizes - including Winning Team, Longest Drive,
Closest to the Pin, and tons of raffle giveaways!!!
Proceeds help to support the James C. Hazlett Jr. Medical Student
Scholarship fund, graduation expenses for senior classmen, and the
philanthropic student organizations of Wayne State University School
of Medicine who actively volunteer in the Metropolitan Detroit community.
An associate professor of anatomy and cell biology, Dr. James Hazlett,
Jr. joined the WSU faculty in 1980, and was instrumental in the design
and implementation of the medical school curriculum. He served as
course director for medical neuroscience and gross anatomy - two
critically important comprehensive areas that are required of all
medical students. In addition, he taught human body dissection, anatomy,
neuropharmacology and neuroanatomy in the School of Medicine. In
2001, he was named assistant dean after serving many years on the
Admission and Curriculum Committees, which then allowed him to play
a critical role in the development of the Year I and II medical doctorate
programs.
The James C. Hazlett Jr. Memorial Scholarship Fund and Annual Golf
Outing were established in honor of Dr. Hazlett's deep commitment
to medical education and student success after his death on February
22, 2005. For more information or to donate to the fund, please contact
Terri Larrew at 313-577-8311.
Share
Your Thoughts on this Article
Back
to top
|
Health
Authority Organizes Free Sports Physicals, Well Child
Care
April
13-17, 2009 8 a.m. to 2:30 p.m.
Northwestern
High School—School Based Health Center Room A- 300
2200
W. Grand Boulevard
Detroit,
Michigan 48202
To
Schedule an Appointment Call (313) 596 0700 x388
Walk-in’s
are Welcome
Editor's
Note: The following is a letter from Detroit Wayne County
Health Authority CEO Chris Allen.
This
collaborative effort will support the athletic programs
of ThinkDetroit PAL and other school and community based
sports programs. In addition to the free physical,
the first 100 youth each day will receive sports backpacks,
all youths will be able to attend workshops on nutrition
and chronic diseases such as asthma and diabetes, as well
as have a chance to take advantage of an array of fun filled
activities.
For
uninsured and underinsured participants, the Health Authority
staff and volunteers will facilitate Medicaid enrollment
through information, screening and application assistance. As
many as one in seven adolescents have no health insurance. One
in three low income adolescents are not covered by Medicaid. More
importantly private insurance coverage of adolescents is
increasingly restrictive. The book Great Transitions:
Preparing Adolescents for a New Century recommends expanding
school-linked health services. This is one
of the reasons the Health Authority will continue to offer
support to one of our most valued safety net partners,
school based health centers.
During
these difficult economic times, it is more important than
ever that the Health Authority take a leadership role in
ensuring access to health care. As part of
the Health Authority’s Team, we ask you to help “get the
word out” about this important event. The co-sponsors
of this event are the southeastern Michigan Medicaid Health
Plans: Health Plan of Michigan, Midwest Health Plan,
Molina Healthcare, Great Lakes Health Plan, Omni Care,
and Pro Care Health Plan.
I
hope we can count on you!
Sincerely,
Chris
Allen
Executive Director and CEO
Share
Your Thoughts on this Article
Back
to top
|
Cigna
Claims Crunch Begins April 20
It has come
the attention of the Detroit Medical News that the major
insurer Cigna will begin requesting documentation with
certain claims as part of a new software application called "Claim
Check 8.5 Knowledge Base Version 42.
The information
comes to DMN though Christie Dando, who chairs the Communications
Committee for the Michigan Medical Group Management Association.
She stated
in an e-mail: "For
all claims on or after April 20th, Cigna will
start requesting office notes for any claims that have
modifier 25 attached on an E/M visit or modifier 59 attached
to a procedure. According to the information
we received, Cigna will allow an E/M visit to be billed
in addition to a procedure, but they will require 'supporting
documentation' before they pay for the E/M visit appended
with modifier 25.
"Worse
yet, any claims billed with modifier 59 will also require
supporting documentation before that procedure is paid.
"This
appears to be another way for a payer to delay payments
to providers. Being required to send manual claims
with office notes and/or op notes attached will delay
speedy payment by months and put an undue burden on our
billing staff."
Share
Your Thoughts on this Article
Back
to top
|
WellPoint
Targeted In Physician Class Action Lawsuit
In
an expansion of its ongoing effort to expose and prohibit
an industrywide health insurance scheme to defraud patients
and physicians of proper reimbursement, the AMA announced
March 25 it is among several medical societies that filed
a class action lawsuit against WellPoint Inc., the largest
health insurer in the United States.
The
lawsuit, filed in Los Angeles federal court, alleges that
WellPoint colluded with others to underpay physicians for
out-of-network medical services, resulting in patients
paying an excessive portion of the medical bill. The AMA
filed similar class action lawsuits last month against
Aetna Health Inc. and Cigna.
“Physicians
will not tolerate an apparent conspiracy that allows health
insurers to play by their own rules without regard to patients,
or the legitimate costs required to care for them,” said
AMA President Nancy H. Nielsen, MD, PhD.
The
Litigation Center of the AMA and State Medical Societies
is supporting the WellPoint lawsuit in partnership with
the California Medical Association, the Connecticut State
Medical Society, the Medical Association of Georgia and
the North Carolina Medical Society.
Visit http://www.ama-assn.org/ama/pub/news-events/news-events/class-action-wellpoint.shtml to
read more from Dr. Nielsen.
Share
Your Thoughts on this Article
Back
to top
|
AMA
To Senate: Make Health Insurer Payments More Transparent
The
AMA testified today to the U.S. Senate Committee on Commerce,
Science and Transportation on the need for increased insurer
payment transparency. Congress can help restore reasonable
compensation for the patients and physicians who were shortchanged
by insurers and promote fair and accurate payments going
forward. This follows recent legal settlements with
insurers for underpayment of out-of-network care.
“We
encourage Congress to pursue increased transparency of
all health insurer payments to improve efficiencies and
savings throughout the health system,” said AMA President
Nancy H. Nielsen, MD, PhD. “Making the insurance payment
system more transparent will help keep the patient-physician
relationship intact, as it can be threatened if patients perceive
that their physician is overcharging for services when
in reality the insurer is underpaying.”
Visit http://www.ama-assn.org/ama/pub/news-events/news-events/health-insurer-payments.shtml to
read more about the AMA’s testimony.
Share
Your Thoughts on this Article
Back
to top
|
|
This publication brought to you by Natinsky
Publishing Network.
Problems seeing this email? You may view it online at http://www.wcmssm.org
To subscribe or unsubscribe to this newsletter contact info@wcmssm.org
|
|
Wayne County Medical Society
of Southeast Michigan.
All Rights Reserved.
|
