United Healthcare terminates Envision contract

[Ezekiel2517]

If you don't know envision, Sheridan was acquired by amsurg in 2014. Amsurg merged with Envision two years later

https://www.bizjournals.com/nashvil...nates-contract-with.html?ana=yahoo&yptr=yahoo

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[aneftp]

This isn’t actually good news.

Do u want anesthesia to have private insurers pay us $16/unit or close to it like Medicare rates?

My brother in California is lucky to get $60/unit from the private insurers. That’s on top of dealing with Medicare and Medi-cal extremely low rates.

Driving down reimbursements is not a good thing. Unless the feds are willing to double the Medicare per unit rate.

This is a race to the bottom.

 

[deleted162650]

Does this just mean that Envision now gets to bill out of network on all United patients?

 

[Aether2000]

Hmmmm....Guess I will be out of a job with Envision since I was the last person hired at this hospital anesthesiology group. Retirement should be entertaining.

 

[deleted899865]

Tagging onto this as Mednax just lost a contract with United Healthcare in 4 southern states. Does anyone know if anything ended up changing with Envision or if it effected them at all?

 

[deleted126335]

Does this just mean that Envision now gets to bill out of network on all United patients?

They do. But at the cost of tremendous anger by the surgeons, hospital administration, patients. That doesn't bode well for a long term relationship.

 

[SitraAchra]

This is all likely tied to the Out of Network billing legislation heading down the pipeline in Congress.

 

[deleted941485]

This isn’t actually good news.

Do u want anesthesia to have private insurers pay us $16/unit or close to it like Medicare rates?

My brother in California is lucky to get $60/unit from the private insurers. That’s on top of dealing with Medicare and Medi-cal extremely low rates.

Driving down reimbursements is not a good thing. Unless the feds are willing to double the Medicare per unit rate.

This is a race to the bottom.

Looks like the collapse of the major staffing companies is imminent. Team health just had their UHC contracts cancelled and the ER docs took a 4% pay cut. Envision was the next step. Mednax next. The commercial payers are going down the hit list reevaluating contracts and disputing charges.

AMCs had it coming from the get go. You can’t skim forever. They’ll try to whip their doctors harder ofcourse

Balance billing legislation is a natural consequence of this type behavior i.e unbridled greed and stupidity.

I still miss for the days of the the local PP staffing the hospital running things the way they see fit but ofcourse the next step will probably be hospital employment.

 

[Arch Guillotti]

I still miss for the days of the the local PP staffing the hospital running things the way they see fit but ofcourse the next step will probably be hospital employment.

A few of us are still doing that. Hospital employment has always been a threat but some of us are holding out.

 

[deleted941485]

A few of us are still doing that. Hospital employment has always been a threat but some of us are holding out.

Stay strong...it is the best way to practice and always was the best way. just sorry that things got so messed up over the years.

 

[DirtDocMD]

Let’s see.... Now, these AMC’s that weaseled their way into hospitals, because they could “reduce hospital stipends, due to their better insurance contracts”, are LOSING these contracts??

This tees me off in TWO ways. Number 1, the AMC’s used this to screw over TONS of private practice groups. Number 2, if the INSURANCE COMPANIES would have simply been willing to up their pay a little to the private practice groups, much of this could have been avoided.

This gets to not only the monopolization of certain local/state markets by AMC’s, but monopolization on a NATIONAL level by Aetna/United/Blue Cross.

And don’t even get me started on how Medicare/Medicaid SHAFTS anesthesia, compared to other specialties. Theyget 60-80% of private pay rates, meanwhile anesthesia is getting 20-35%......

 

[Mman]

Let’s see.... Now, these AMC’s that weaseled their way into hospitals, because they could “reduce hospital stipends, due to their better insurance contracts”, are LOSING these contracts??

This tees me off in TWO ways. Number 1, the AMC’s used this to screw over TONS of private practice groups. Number 2, if the INSURANCE COMPANIES would have simply been willing to up their pay a little to the private practice groups, much of this could have been avoided.

This gets to not only the monopolization of certain local/state markets by AMC’s, but monopolization on a NATIONAL level by Aetna/United/Blue Cross.

And don’t even get me started on how Medicare/Medicaid SHAFTS anesthesia, compared to other specialties. Theyget 60-80% of private pay rates, meanwhile anesthesia is getting 20-35%......

Please be clear, I'm almost certain that these contracts being terminated is the fault of the insurance companies and not the AMCs. The AMCs are on our side when it comes to insurance contracts. The insurance companies are heavily lobbying to get out of network bills passed that tie those rates to Medicare or something else obscenely low. Then when they lowball you on your next contract if you don't accept it they simply pay you Medicare rates while out of network. Which then means we will all be out of network and all be getting Medicare rates while the insurance company pockets the difference.

AMCs are not a great thing for anesthesiologists, but they are 100% on our side when it comes to fair negotiation of insurance contracts for physicians services.

 

[lane]

Insurance companies spend $240-500 million per year on lobbying, and it’s certainly not to protect private practices‘ best interests.

 

[deleted941485]

Please be clear, I'm almost certain that these contracts being terminated is the fault of the insurance companies and not the AMCs. The AMCs are on our side when it comes to insurance contracts. The insurance companies are heavily lobbying to get out of network bills passed that tie those rates to Medicare or something else obscenely low. Then when they lowball you on your next contract if you don't accept it they simply pay you Medicare rates while out of network. Which then means we will all be out of network and all be getting Medicare rates while the insurance company pockets the difference.

AMCs are not a great thing for anesthesiologists, but they are 100% on our side when it comes to fair negotiation of insurance contracts for physicians services.

A. Commercial payers are doing this to force AMCs to come to the table and bargain because they know the BB legislation as others have pointed out will force them back in network at lower rates

B. You are absolutely right about AMCs being in our side when it comes to negotiations but with one caveat they aren’t fighting for you they are fighting for the margin they get to skim off the top that is all

 

[Mman]

A. Commercial payers are doing this to force AMCs to come to the table and bargain because they know the BB legislation as others have pointed out will force them back in network at lower rates

B. You are absolutely right about AMCs being in our side when it comes to negotiations but with one caveat they aren’t fighting for you they are fighting for the margin they get to skim off the top that is all

since I am in a private practice, they are also fighting for me. And even if you are an employee of an AMC, you will certainly pray they are skimming from $125 a unit instead of skimming from $25 a unit.

 

[deleted941485]

since I am in a private practice, they are also fighting for me. And even if you are an employee of an AMC, you will certainly pray they are skimming from $125 a unit instead of skimming from $25 a unit.

I agree with you which is why I thing they need to throw their heart and soul into stopping it and also come up with contingencies if it fails upfront payments etc whatever.

Anyway when the dust settles again, we will be back fighting them.

 

[deleted126335]

Please be clear, I'm almost certain that these contracts being terminated is the fault of the insurance companies and not the AMCs. The AMCs are on our side when it comes to insurance contracts. The insurance companies are heavily lobbying to get out of network bills passed that tie those rates to Medicare or something else obscenely low. Then when they lowball you on your next contract if you don't accept it they simply pay you Medicare rates while out of network. Which then means we will all be out of network and all be getting Medicare rates while the insurance company pockets the difference.

AMCs are not a great thing for anesthesiologists, but they are 100% on our side when it comes to fair negotiation of insurance contracts for physicians services.

Kinda like the USA fighting on the same side as Al Qaeda in Syria.

 

[Deanmonster]

Please be clear, I'm almost certain that these contracts being terminated is the fault of the insurance companies and not the AMCs. The AMCs are on our side when it comes to insurance contracts. The insurance companies are heavily lobbying to get out of network bills passed that tie those rates to Medicare or something else obscenely low. Then when they lowball you on your next contract if you don't accept it they simply pay you Medicare rates while out of network. Which then means we will all be out of network and all be getting Medicare rates while the insurance company pockets the difference.

AMCs are not a great thing for anesthesiologists, but they are 100% on our side when it comes to fair negotiation of insurance contracts for physicians services.

The AMCs are not on your side with insurance negotiations or anything else. You bear the patient's ire for exorbitant billing while the company pockets the difference. The AMCs hurt you in the long run and the short run.

 

[Mman]

The AMCs are not on your side with insurance negotiations or anything else. You bear the patient's ire for exorbitant billing while the company pockets the difference. The AMCs hurt you in the long run and the short run.

The AMCs are fighting against insurance companies being able to pay you medicare rates for their patients. Whether you want to admit it or not, that helps physicians.

Feel free to lobby for medicare rates for out of network physicians because then the patients will love you. Except they won't because their premiums will still be sky high and yet your income will be miniscule and the insurance company will have even better profit margins.

 

[deleted941485]

The AMCs are fighting against insurance companies being able to pay you medicare rates for their patients. Whether you want to admit it or not, that helps physicians.

Feel free to lobby for medicare rates for out of network physicians because then the patients will love you. Except they won't because their premiums will still be sky high and yet your income will be miniscule and the insurance company will have even better profit margins.

It’s probably better to just stand with the AMCs on this one. going against them will make even PPs suffer. They’ll another time to fight AMCs and this probably isn’t it.

Patient love shouldn’t even be a consideration for docs fighting this. Their love isn’t gonna pay back my loans or make my house payments.

 

[nimbus]

What's in store for new Envision CEO James Rechtin — 7 company insights

After Christopher Holden's resignation, Envision Healthcare tapped James Rechtin — the president of OptumCare — to take over as president and CEO.

www.beckersasc.com

 

[mmag]

What's in store for new Envision CEO James Rechtin — 7 company insights

After Christopher Holden's resignation, Envision Healthcare tapped James Rechtin — the president of OptumCare — to take over as president and CEO.

www.beckersasc.com

I wonder when AI is going to take over writing Becker "articles". I can't believe they pay someone to summarize press releases with formulaic headlines.

 

[nimbus]

I wonder when AI is going to take over writing Becker "articles". I can't believe they pay someone to summarize press releases with formulaic headlines.

It’s Anesthesiology News style non-journalism. AI could probably do a better job.