IDR is Effective in Ensuring Fair Payment. Health Plans Want to Kill It.
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Colleagues:
How would you feel if you were called to the ER, did emergency work, but were only paid pennies on the dollar?
This past June, a breast cancer survivor came to an ER on Long Island with a worsening fever and acute left breast pain, which turned out to be a ruptured breast implant. This particular implant had been recalled due to implant-associated anaplastic large cell lymphoma. Due to the severity of the infection and her history of cancer, mastectomy and radiation, a board-certified plastic surgeon saw her for emergency consultation in the ER and performed urgent surgery within 24 hours. For this urgent surgery and 3 in-office follow up visits with this patient, the patient’s Medicaid Managed care paid this plastic surgeon only a few hundred dollars.
The surgeon served a request for negotiations on the health plan to seek further reimbursement and the plan completely ignored him. Six months after the surgery, the physician was left with no choice but to file an IDR as the plan was refusing to even negotiate. Another 2+ months passed and, finally, he was awarded an additional reasonable amount by the independent arbitration.
If the IDR program had not existed, the plan would have succeeded in cheating this surgeon. However, the IDR program is in jeopardy. As this Pulse message is being written, New York’s Health Plan Industry is working extremely hard to eliminate your ability to challenge their repeated underpayments from the Medicaid budget, their lobbyists have the Governor’s ear on this, and they have just published paid advertising with misleading misinformation
Now is the time to take action. Please urge your legislators to reject the salacious and misleading claims from the health insurance industry and protect your right to appeal to the Independent Dispute Resolution. Please also support MSSNYPAC and MSSNY so we can place strategic advertisements in select media to oppose this action. But this takes money, and the need is now. I urge you to donate to MSSNYPAC today by clicking here. And if you are not yet a member of MSSNY, you can join here.
All the best,
Jerome C. Cohen, MD
MSSNY President
