Re: Capitation
From: art fougner, md (evsono@pipeline.com)
Sat Jun 3 12:24:23 2000
great advice - definitely show this contract to a lawyer. also, forward
a copy to your state and county medical society for review. this case
argues eloquently for the passage of house 1304 - the campbell
anti-trust bill, which is in trouble btw.
art
At Fri, 2 Jun 2000, Kenneth A. Thomas, M.D. wrote:
>
>At Sun, 14 May 2000, Pam Palmer wrote:
>>
>>It has been my experience over the past several years dealing with a
>>capitated carrier. Now, the carrier has
>>decided to change the contract and now make this a fee for service
>>contract.
>>
>>I know this should be good news, but we do not have the fee schedule
>>yet, and I've been told its equal to medicare rates. The contract reads
>>that once sign, they can alter the contract and not have approval. Also,
>>the change effects the current patients that have been seen. We no
>>longer are paid for the patients we've seen in the last 3
>>months. It will mean a loss of thousands of dollars.
>>
>>The carrier stated since we are up for renewal we have no choice but to
>>sign or get out. We can't afford to get out but is there a way to fight
>>the contract or the losses. The fact is this is 30% or more of our
>>patient load.
>>
>>Do you have any advice or suggestion. My e-mail address is
>>wapp88@gateway.net.
>>
>>Thank you!
>
>Pam;
>What did your lawyer say about the insurer's obligation to continue the
>monthly capitation payments until the changeover to fee-for-service? I
>cannot believe that the insurer can erase three months of capitation
>payments retroactively.
>You can't easily drop out of a plan that represents 30% of your
>revenues, but you can remain in the plan and diplomatically let your
>participating patients know how unhappy you are with the insurer. Since
>many of them are probably also unhappy, they may ask you which plans you
>recommend. If they like you, and if they trust you, they will listen to
>you. And as you get these patients to switch to better plans, you may
>yourself less dependent on this plan...and maybe in a year or two, you
>can afford to drop out of it completely.
> Try it. Good luck.
> KT
>
>--
>Ken Thomas, M.D. F.A.C.O.G.
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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