"Pain Management panel is closed", now what? Need serious advise.

[paindoctn]

I searched around the forums but still cannot find a solution.

I just branched out on my own from the old group only to find out that UHC panel is closed to new Tax ID numbers. They say that they have enough providers. I wrote appeal letters, called them, emailed them, called their physician advocate at the headquarters - same answer. UHC is easily 1/3 of my local market. It's a monopoly that can do anything they want. PCPs do not want to send patients to the new pain doc "who can that this, this and this insurance but not that, that and that insurance". Stuck in a 3 yr lease with the office.

Can someone offer a real advise besides "should have thought about it before" - UHC credentialing took 4 months to reject my application, "call them again" and "go to North Dakota" ? This is a new dilemma that will be affecting ALL of us from this point on. Means no one can EVER move out of their old location or new grads are out of their chance to ever go solo.

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[pmrmd]

Have patients of yours with that insurance call and demand you be a covered physician. Initially Cigna did this to me and after 1-2 years they included me.

 

[drusso]

I searched around the forums but still cannot find a solution.

I just branched out on my own from the old group only to find out that UHC panel is closed to new Tax ID numbers. They say that they have enough providers. I wrote appeal letters, called them, emailed them, called their physician advocate at the headquarters - same answer. UHC is easily 1/3 of my local market. It's a monopoly that can do anything they want. PCPs do not want to send patients to the new pain doc "who can that this, this and this insurance but not that, that and that insurance". Stuck in a 3 yr lease with the office.

Can someone offer a real advise besides "should have thought about it before" - UHC credentialing took 4 months to reject my application, "call them again" and "go to North Dakota" ? This is a new dilemma that will be affecting ALL of us from this point on. Means no one can EVER move out of their old location or new grads are out of their chance to ever go solo.

It also reduces career mobility for employed MD's.

 

[NJPAIN]

Had the same thing happen with Aetna. This is their new game. Not only do you have no ability to negotiate the contracted fees but now you have to beg to take the crap fees. They are totally in control. It's called divide and conquer. If we all refused to work for what they pay we would have something but as soon as some cave in it cuts everyone else's throat.

 

[ampaphb]

See them out of network, and agree to accept the same amount as what UHC would have paid you. This will cost you a few bucks initially, but you will

1) keep your referral sources happy
2) as you build up a critical number of UHC patients, they will view you as a valuable comodity they need as part of their network

 

[nervouspremed]

I searched around the forums but still cannot find a solution.

I just branched out on my own from the old group only to find out that UHC panel is closed to new Tax ID numbers. They say that they have enough providers. I wrote appeal letters, called them, emailed them, called their physician advocate at the headquarters - same answer. UHC is easily 1/3 of my local market. It's a monopoly that can do anything they want. PCPs do not want to send patients to the new pain doc "who can that this, this and this insurance but not that, that and that insurance". Stuck in a 3 yr lease with the office.

Can someone offer a real advise besides "should have thought about it before" - UHC credentialing took 4 months to reject my application, "call them again" and "go to North Dakota" ? This is a new dilemma that will be affecting ALL of us from this point on. Means no one can EVER move out of their old location or new grads are out of their chance to ever go solo.

Will joining an IPA help with situation like this? Maybe some of the more experienced people on this forum will know.

 

[hyperalgesia]

I searched around the forums but still cannot find a solution.

I just branched out on my own from the old group only to find out that UHC panel is closed to new Tax ID numbers. They say that they have enough providers. I wrote appeal letters, called them, emailed them, called their physician advocate at the headquarters - same answer. UHC is easily 1/3 of my local market. It's a monopoly that can do anything they want. PCPs do not want to send patients to the new pain doc "who can that this, this and this insurance but not that, that and that insurance". Stuck in a 3 yr lease with the office.

Can someone offer a real advise besides "should have thought about it before" - UHC credentialing took 4 months to reject my application, "call them again" and "go to North Dakota" ? This is a new dilemma that will be affecting ALL of us from this point on. Means no one can EVER move out of their old location or new grads are out of their chance to ever go solo.

Just advertise that you accept them and only ask pts for the copay until things change. If you can't afford to do that, you should just try to get out of your lease/sublease and chalk it up to a learning experience. Also, you should definitely try to get in under your primary specialty. In one of my panels I had to do that and it worked just fine.

 

[miamidoc2b]

Sneak in via primary specialty.

Hire a GOOD healthcare attorney

 

[NJPAIN]

I like the primary specialty idea. Any anesthesiologist out there resorted to that and been successful?

 

[ampaphb]

Fraud is subject to trebble damages, if u get caught

 

[Papa Lou]

I echo the thoughts on hiring a good (expensive) healthcare attorney. they should know all the tricks that work in that state and have plenty of experience.
getting in through your primary specialty is something I never considered...great idea if it works for you.
keep your referral sources happy. accrue patients. keep looking for answers and ways to advance.

another idea is just go straight cash model, with incentives for patients. things most other pain docs can't provide.

 

[hyperalgesia]

Fraud is subject to trebble damages, if u get caught

Why are you trying to scare people with your big lawyer words? There's nothing illegal or fraudulent about an anesthesiologist or physiatrist doing pain procedures.

 

[ampaphb]

Joining the UHC family practice panel with the intent of practicing pain management is fraud.

Btw, I didn't realize a one syllable rose to the level of a "big lawyer word". Terribly if that was too much for you.

 

[hyperalgesia]

Joining the UHC family practice panel with the intent of practicing pain management is fraud.

It happens all the time. UHC doesn't have to pay. A guy I know is pmr and highmark in Pittsburgh refuses to pay him for u/s that he does because he's not a radiologist. Trying to sue or arrest him would be ludicrous. Pain management is certainly within the scope of pmr and anesthesia. I don't necessarily support it, but fraud? Come on. We don't have to tip toe around insurance bureaucracies.

 

[paindoctn]

Thanks for all the advises above:

Let me kinda summarize:
1) 1-2 years of asking your pts to keep calling UHC, hoping they might feel sorry for you and cave in eventually? Might be an option... I am not throwing it away, will definitely keep in mind.

2) see patients OON, but charge them the same as in-network? Why would UHC ever extend a contract to me then? I cost them the same and they keep their numbers of in-network providers locked.

3) IPA route? I tried to go down that path. They do not even want to hear about a "Pain Management" guy. They could care less that I am a double boarded ABMS neuro/pain guy w/ ACGME pain fellowship. My area (East TN) is infested with PA-run pill mills that give our specialty terrible reputation. The irony is that all those PA clinics are "old Tax ID #'s" and are in-network with UHC.

4) Primary specialty route. I emailed UHC Senior Network Specialist after I got rejected for pain panel, the guy saw right through it. "Unfortunately, at this time..... We are closed for both neurology and PM panels... blah-blah-blah". I called a local neuro group, they are booking new pts for 3 months in the future, huge shortage of general neuro docs here.

5) Cash model? Not an option for me. How would I be any different from those pill mills that are all over the place?

6) Good (expensive) attorney route. I might go to that eventually. However, I see a real conflict of interest here: what's the incentive for anyone who bills me $350-400/ hr to ever finish the case and not to drag it out indefinitely? Suing UHC - I will go belly up a lot faster than UHC with their billions of $$$ and legal teams.

Any other ideas guys? I honestly appreciate all the advises.

PS Please don't turn this into kindergarten sand box, no need to throw poop at each other. PM each other if you absolutely have to do that. I want to talk to smart adults here, that's why I started this thread.
Thx.

 

[ampaphb]

see patients OON, but charge them the same as in-network? Why would UHC ever extend a contract to me then? I cost them the same and they keep their numbers of in-network providers locked.

Charge THE PATIENT so that they only have to pay the same amount as they would an in-network provider. Charge UHC your usual 3-4x Medicare.

 

[pmrmd]

Write/call/visit your state representative. Ask for state legislation that does not allow the actions of UHC given they have such large market share. The state gives you the power to practice. UHC should not be able to pick favorites for all plans, only perhaps some plans. As docs we should be demanding this anyway. We should all be contracted or offered to be contracted with every plan offered and it is up to us to accept it. After all, the whole ACA thing was supposed to be about insurance coverage AND access, not coverage with limited access.

 

[paindoctn]

Charge THE PATIENT so that they only have to pay the same amount as they would an in-network provider. Charge UHC your usual 3-4x Medicare.

Please clarify. If Medicare pays $100 for whatever service, how can I charge the UHC pt $100 and $300-400 at the same time? Please clarify.

 

[paindoctn]

Write/call/visit your state representative. Ask for state legislation that does not allow the actions of UHC given they have such large market share. The state gives you the power to practice. UHC should not be able to pick favorites for all plans, only perhaps some plans. As docs we should be demanding this anyway. We should all be contracted or offered to be contracted with every plan offered and it is up to us to accept it. After all, the whole ACA thing was supposed to be about insurance coverage AND access, not coverage with limited access.

That's a good thought, which ones should I write to? There is a state governor Bill Haslam In Nashville, there are representatives from the state of TN in Washington, should I write to them? I guess my question is: What agency/ people is UHC most afraid of? Is there some agency that regulates UHC as an insurance company at the state level? I vaguely remember that auto insurance companies are afraid of some regulatory agency, forgot what agency that was though.

 

[pmrmd]

^The governor and your state congressmen/women could be more effective than your U.S. congressional delegation for this but what do I know? Contact them all.

 

[SSdoc33]

Fraud is subject to trebble damages, if u get caught

but, you can always recoup that money with your BASS charges.

anyone? anyone?

 

[ampaphb]

.

 

[ampaphb]

Please clarify. If Medicare pays $100 for whatever service, how can I charge the UHC pt $100 and $300-400 at the same time? Please clarify.

What an organization pays has nothing to do with what you charge.

In network means you have agreed to accept a discounted rate. So even if you charge $500, you have agreed to accept $100 as payment in full.

Out of network means no such contracted rate exists. You bill $500, you expect to get paid $500. There is ongoing litigation about this, as many insurers then pay you a percentage of usual and customary rates, not your charges, as they should. They have also separate in-network deductibles from out-of-network. So even if the patient has met his in-network deductible of $2500, he may still have an unmet $5000 out-of-network deductible.

You can bill the carrier the full $500 in charges, but then only expect to recoup $100 from the patient.

 

[specepic]

what about affiliating with a group or hosp that wants a presense in the area you rented?

It sounds like you are in tough spot unless you want to break the lease, which is prob cheaper than fighting UHC.

 

[hyperalgesia]

4) Primary specialty route. I emailed UHC Senior Network Specialist after I got rejected for pain panel, the guy saw right through it. "Unfortunately, at this time..... We are closed for both neurology and PM panels... blah-blah-blah". I called a local neuro group, they are booking new pts for 3 months in the future, huge shortage of general neuro docs here.

A few years ago I applied as a pain doc. Was denied, "Panel is full".
I didn't raise any hell or draw attention to myself. They forgot about me.
About 10 months later, I applied as a PMR doc and got right on.
Some things require subtlety.
You might have luck with the other ideas, raising hell, hiring flashy lawyers, calling your congressmen, etc, I don't know...
But also, this is certainly not gonna be your only challenge. PCPs are not gonna alter their referral pattern just bc you're on the same insurance as everyone else. I've always had another employed job so could afford to wait them out. If you have overextended yourself, it's best to get out of your lease, take a loss, regroup and live to fight another day.

 

[Papa Lou]

The lawyer route is not to sue them.

The lawyer route is to get information. You're asking a bunch of amateurs what you should be asking a professional. If they end up not doing anything for you other than that phone call you may not even be charged a dime. I believe you should get ready to pony up the money to the region's expert, and in exchange get council on which ways to move forward. The top dog lawyers are not only more creative than us, but they've seen it all (you're not the first). Cool? Pay the money.

 

[paindoctn]

The lawyer route is not to sue them.

The lawyer route is to get information. You're asking a bunch of amateurs what you should be asking a professional. If they end up not doing anything for you other than that phone call you may not even be charged a dime. I believe you should get ready to pony up the money to the region's expert, and in exchange get council on which ways to move forward. The top dog lawyers are not only more creative than us, but they've seen it all (you're not the first). Cool? Pay the money.

May be you are right LOL

 

[Doctodd]

Join an umbrella group who is already contracted with UHC(at probably a higher rate). You stay solo but bill under their contracts. Yes it takes a leap of faith.

Try Twitter and other social media. See other thread. UHC doesn't care about what you say.....unless it affects their bottom line.

 

[mille125]

I agree that this is an issue that can effect us all. I would go OON. Take their patients to an OON surgery center as well. They will eventually get the hint.

Otherwise, try to find a local PHO or IPA where you can get on United through them.



Take an OON stimulator to an OON surgery center and they will shell out six figures...

I searched around the forums but still cannot find a solution.

I just branched out on my own from the old group only to find out that UHC panel is closed to new Tax ID numbers. They say that they have enough providers. I wrote appeal letters, called them, emailed them, called their physician advocate at the headquarters - same answer. UHC is easily 1/3 of my local market. It's a monopoly that can do anything they want. PCPs do not want to send patients to the new pain doc "who can that this, this and this insurance but not that, that and that insurance". Stuck in a 3 yr lease with the office.

Can someone offer a real advise besides "should have thought about it before" - UHC credentialing took 4 months to reject my application, "call them again" and "go to North Dakota" ? This is a new dilemma that will be affecting ALL of us from this point on. Means no one can EVER move out of their old location or new grads are out of their chance to ever go solo.

 

[Papa Lou]

I agree that this is an issue that can effect us all. I would go OON. Take their patients to an OON surgery center as well. They will eventually get the hint.

Otherwise, try to find a local PHO or IPA where you can get on United through them.



Take an OON stimulator to an OON surgery center and they will shell out six figures...

Doesn't this end up costing the patient tons of money? They likely have a separate OON deductible of like 5k they have to meet for these procedures at the OON ASC. The OON thing confuses the hell out of me. Ultimately the patient is responsible for a large amount of money right? I'd rather not do that to patients unless I explicitly explain it all to them and they have enough understanding/capacity to go for it.

 

[paindoctn]

My concern exactly, OON is only good in theory. In reality majority of patients have huge SEPARATE OON deductible besides the In Network deductible. Pt will have to cough up something like ~ 5K OON deductible before UHC will even step into the game at 50:50 split (insurance/ pt) after OON deductible is met. And don't forget, commercials like to send OON checks to patients instead of your office. Try to chase that pt with YOUR check afterwards, good luck.

I've been toying with an idea of charging OON UHC pts Medicare x 1 rates. I've been told that one is allowed to have different fee schedules for different insurances as long as you are NOT billing them LESS THAN WHAT YOU BILL TO MEDICARE. This way at least I'll be seeing UHC pts and not appear as too picky of a doc to the local PCPs (they like clinics that take all insurances, it's just easier for the referring girls from PCPs offices). In the meantime I'll ask my UHC pts to call and complain to UHC on my behalf. Just one of the ideas.

Spoke to my EMR billing dept, they are saying it's happening all over the country now, she named ~ 6-7 states. She said that their clients were NOT successful going the legal route. She said that UHC throws out doctors that are already in-network with UHC for many years.

 

[drpainfree]

To OP, let's say you only charge UHC at Medicare rate, how do you address OON deductible (much higher than IN deductibles)?

 

[paindoctn]

Let's say both Medicare and in-network UHC visit costs 100$. That $100 goes towards the in-network UHC deductable. Usually, OON fees are set to be 4-5x Medicare rate. No pt likes to get slammed w/ $500 visit OON. If I charge $100 OON UHC visit it goes towards OON deductable. Essentially, I'll be stock doing med refills and avoiding procedures until the situation is resolved. Or I can hire a PA in the future to do those med refills for me.

 

[Gastrapathy]

Hire one of the PAs with a tax id#.

Call your state insurance commissioner.

 

[paindoctn]

Hired PA goes under my tax id, he/she joins me. They are W2 employees.

Thought about insurance commissioner, this is "an all out war" approach. I am afraid that if I go that route and lose, UHC will put me in some "black list" forever. Even if I move to North Dakota in 3yrs, I can forget about EVER getting on board UHC.

But I will ask my PATIENTS to file complaints w/ the state consumer affairs. If enough pts complain about the same organization, it ends up on the table of Attorney General.

 

[Jcm800]

Whatever happened here for you?

 

[epidural man]

Fraud is subject to trebble damages, if u get caught

come one...this is ridiculous.

A medical license allows you to practice ANY TYPE of medicine you want and feel comfortable. There is no such thing as practicing pain medicine, or practicing internal medicine, or practicing dermatology. Hospitals may credential a clinician to certain procedures, or maybe even certain medications.

But to say an ob/gyn can't give motrin to a patient for a head ache and then charge for it because that is practicing pain and their job is to practice ob/gyn is ludicrous. I can't believe you even said that.

 

[Tenesma]

1) be happy - it is better to be out of network than in network...

2) most patients have HUGE deductibles - so they really can't tell the difference between in network or out of network anyway...

 

[Ducttape]

1) be happy - it is better to be out of network than in network...

2) most patients have HUGE deductibles - so they really can't tell the difference between in network or out of network anyway...

Oh yes they can. I have at least 50-80 patients over the past year that switched to me due to network status

 

[paindoctn]

An update from my earlier posts from Feb 2015: I wrote whole bunch of complaints to the headquarters of UHC in Minnesota, spoke to their Provider relationship advocate at their headquarters, that got me nowhere. I got a polite letter from UHC that I've "exhausted 3 appeal attempts" and should just crawl into a corner and die. Well, I didn't. I applied for a TN Medical Association membership (it's the biggest group of MDs here in TN). Once I became a member, I spoke to their provider advocate, she had some connections at UHC. I wrote a LOOOONG angry letter for her to forward to her UHC contacts at their high levels of hierarchy . After that, time passed and I kinda forgot about the whole UHC thing ("to Hell with it"). Well, 2 weeks ago I got a contract with UHC in the mail. Signed it and I am effective as of 8/22/15.

Not sure if that was her, or just multiple appeal letters but I got my contract.

BTW, Being OON sucked, I had a few UHC OON pts and besides paying $50 copays, essentially entire visit cost went toward their OON deductable which is huge and they were on a hook for it. So I couldn't even offer them a simple TPI let alone ESI. All I did was 99213 visits and pts were complaining constantly. Lost a few to competition, loyal ones changed to other insurances that I do take in network.

The moral of the story: never give up, if you knock on many doors, one of them will open up.

BTW Love being solo, just got my website up and running. It's also in my profile, would welcome any suggestions on how to improve it from the seasoned guys. Saw 35 pts today, we were running non-stop, thinking about hiring a PA and expansion plans.

thanks guys for all the advice in previous posts.

 

[Tenesma]

It is all in how u educate pts. And sell ur value.... I'd rather be out of network w a chappy ins and grow my good payers....

Heck if u are seeing 35 pts a day why even worry about united

 

[paindoctn]

Need to clarify above, I am in my own office only M,W,F and sloooowly transitioning myself out of the old employer's place. This way my income is not plummeting to zero during the transitional period. It took me 8 months to build those 3 days to 30-35 pts/ day. It was definitely not an overnight success, I have to elbow my way into a very supersaturated market.
But I am feeling better about the fact that I am NO LONGER having to beg for the extra MA hours and paper clips at my old employer's place. It gets old really fast. YOU WILL NEVER BE HAPPY WORKING FOR SOMEONE ELSE.
If someone is miserable at some group somewhere and is sitting on a fence, my only advise is to close your eyes and jump into a solo. Better die trying than live in misery. my 2c. I am glad I did, was scared $%^&less 8-9 months ago. Too bad I did not do that 10 yrs ago, fear paralyzes your thinking.

 

[Stim4me]

Need to clarify above, I am in my own office only M,W,F and sloooowly transitioning myself out of the old employer's place. This way my income is not plummeting to zero during the transitional period. It took me 8 months to build those 3 days to 30-35 pts/ day. It was definitely not an overnight success, I have to elbow my way into a very supersaturated market.
But I am feeling better about the fact that I am NO LONGER having to beg for the extra MA hours and paper clips at my old employer's place. It gets old really fast. YOU WILL NEVER BE HAPPY WORKING FOR SOMEONE ELSE.
If someone is miserable at some group somewhere and is sitting on a fence, my only advise is to close your eyes and jump into a solo. Better die trying than live in misery. my 2c. I am glad I did, was scared $%^&less 8-9 months ago. Too bad I did not do that 10 yrs ago, fear paralyzes your thinking.

Amen brother... I wish Md's had bigger balls or larger ovaries....strong work..

 

[Tenesma]

fear is a bad disease that limits a lot of our potential...

 

[Vandalia]

come one...this is ridiculous.

A medical license allows you to practice ANY TYPE of medicine you want and feel comfortable. There is no such thing as practicing pain medicine, or practicing internal medicine, or practicing dermatology. Hospitals may credential a clinician to certain procedures, or maybe even certain medications.

But to say an ob/gyn can't give motrin to a patient for a head ache and then charge for it because that is practicing pain and their job is to practice ob/gyn is ludicrous. I can't believe you even said that.

And insurance companies aren't stupid when it comes to money. (Well, in the short term at least.)

In the massive contract that you sign, it will almost certainly have precise definitions for the specialty you sign up for including allowable patient demographics, diagnosis and CPT codes. There are herds of lawyers employed by the insurance company who sit around all year writing the language to ensure that if you sign on as (for example) a family physician, you are/will be practicing as a family physician. If you sign the contract, certifying, for example "I am board certified in Family Medicine. My practice consists of individuals of all ages and genders with primary care complaints. The distribution of ICDM codes and CPT codes that I have seen over the last year is consistent with that for family medicine physicians in my region as shown in Appendix A. I understand that if during any 3 month period the demographic distribution of claims that I submit are inconsistent with those of a family physician - as defined in Appendix B - I agree my contract can be suspended at the sole discretion of the insurance company and I may be liable to repay all fees paid during this contract period." (Now just translate that to much more specific and complicated legalese.)

Legally, with your medical license, you are not restricted to a specific specialty. However, when you accept a contract that has pages specifically defining a particular specialty, and you (falsely) sign attesting that you have and will continue to practice that other specialty - as specifically defined with concrete parameters in the contract - then you are liable to civil and criminal prosecution for fraud.

And, believe me, when your claim pattern starts to drift even slightly from your peers in the same (official) specialty/geographic area, a hoard of auditors will descend to look over your charts and begin to investigate you for fraud.

 

[Tenesma]

those contracts are terrible - and i bet that the MAJORITY of docs never read the contracts line by line. ... they are just happy to be blessed with a contract.

i can tell you that the 3 years of my private practice that i was out of network with United, were my happiest and my financially best years... will seriously be a lot more picky about contracts when i go back to pp

 

[epidural man]

And insurance companies aren't stupid when it comes to money. (Well, in the short term at least.)

In the massive contract that you sign, it will almost certainly have precise definitions for the specialty you sign up for including allowable patient demographics, diagnosis and CPT codes. There are herds of lawyers employed by the insurance company who sit around all year writing the language to ensure that if you sign on as (for example) a family physician, you are/will be practicing as a family physician. If you sign the contract, certifying, for example "I am board certified in Family Medicine. My practice consists of individuals of all ages and genders with primary care complaints. The distribution of ICDM codes and CPT codes that I have seen over the last year is consistent with that for family medicine physicians in my region as shown in Appendix A. I understand that if during any 3 month period the demographic distribution of claims that I submit are inconsistent with those of a family physician - as defined in Appendix B - I agree my contract can be suspended at the sole discretion of the insurance company and I may be liable to repay all fees paid during this contract period." (Now just translate that to much more specific and complicated legalese.)

Legally, with your medical license, you are not restricted to a specific specialty. However, when you accept a contract that has pages specifically defining a particular specialty, and you (falsely) sign attesting that you have and will continue to practice that other specialty - as specifically defined with concrete parameters in the contract - then you are liable to civil and criminal prosecution for fraud.

And, believe me, when your claim pattern starts to drift even slightly from your peers in the same (official) specialty/geographic area, a hoard of auditors will descend to look over your charts and begin to investigate you for fraud.

Well hopefully physicians line-out items that limit scope of practice that they want to do because it seems a little ridiculous that an insurance company is going to dictate practice.

To call out "FRAUD" to someone who is a well trained and good at something that other physicians with the same title aren't comfortable doing seems very odd to me indeed.

 

[Stim4me]

United health care is great at stalling payments, paying selective codes, delaying others, asking for clinical notes, etc... All with the hope your biller gives up... As I mentioned in prior threads, I was fed up and called it quits when they tried to force their Aca plan into the mix. I gave them the middle finger and they gave me a contractual raise after ten years... You need to fight these pricks, we have some power... It depends on your market and competition, which is getting bleak with the consolidation of hc

 

[geauxg8rs]

I actually think consolidation (ie hospitals buying up pp groups) could theoretically give us guys in office based practices a valid argument?
Treat us fairly or the alternative is an overpriced procedure at the local HOPD?

Again in a perfect world it makes sense,so it prolly won't work with medicine.

 

[Stim4me]

I actually think consolidation (ie hospitals buying up pp groups) could theoretically give us guys in office based practices a valid argument?
Treat us fairly or the alternative is an overpriced procedure at the local HOPD?

Again in a perfect world it makes sense,so it prolly won't work with medicine.

Agree with better patient care model... However payer mix is becoming a major issue... Used to be great, competitive, and negotiable... From what I see, bcbs says screw you, aetna says we still want pp....