Re: FW: Oxford and restrictive plans

[Guest guest]

Dear Barry and all:

Having followed all the traffic on the ever increasing reimbursement

crunch we all seem to find ourselves I find it difficult to remain merely a

" lurker. "

Oxford seems to be just another third party payer who has incorporated

one of the newest " dodges " to restrict our services to legitimate patient

care. The " ruse " of requiring a new precert for treatment is very similar to

tactics we have experienced here in Ohio with different payers. Our problem

with the delay and inconvenience to the patient is that most of our patients

are not upset, even when we explain that it is their insurance company that

is causing the problem. I would have to agree with Ken when he said that the

payers have organizations and associations to which they belong. If we are

still so naive to think that they are not " discussing " reimbursement

strategies then we should be ashamed. This is one concern I have addressed

on numerous occasions with our National reimbursement dept. If we had a

central clearing house that received the changing tactics by the payers

perhaps we could address the growing trend of new crunches that certainly

hits at the pay windows of the private practitioners on an almost daily

occurrence. From what I cannot gather, however, is the same thing happening

to OP PT at the hospitals, or with other providers? If not, then can there

be some legal action considered for discrimination?

As for the coverage issue, we have had occasions where the " so called

treatment " is covered, it just isn't reimbursed according to the rules that

the payer elects to pay. Similar to what Oxford appears to be saying.

Barry, if you are indeed giving treatment anyway with that initial visit then

they are winning and we are falling into their well conceived plan to deny

payment and the patient becomes satisfied, not because their coverage was

good but because you were so benevolent. It is my humble opinion that we

have done this since the inception of Medicare if not before and we are not

making the smart " business " decision because we are less business and more

patient oriented. I have staff who continue to give the store away and in

the end it costs jobs and practices. I get really exercised by the fact that

I can no longer run my practice the way I want to run it. That being the

case then one has to follow the rules tightly and demand that the same rules

apply across the board. Here is where I think our association has to adopt a

change in philosophy. If we have to do it then everybody must play by the

same rules and we all know that the payers are creating new " interpretations "

and saving lots of bucks in the meantime. In the end the patients are

shortchanged and we continue to experience higher practice costs and lower

reimbursement.

I applaud Rick's efforts, we are doing similar activities through our

state network. Overall, I think we need a much more harsh approach by

turning in the offending payers to state Insurance commissions, report all

plan interpretations to your state legislators and Medicare/Medicaid plans to

your federal legislators, and keep copies and send them to our association.

I don't think we can win this one by ourselves, this is growing and we

haven't the resources to outlast the payer community.

In closing, I do not believe for a moment that payers are independently

conceiving these new payer schemes on their own. I quit believing in the

tooth fairy a long time ago. How long do we want to bet on how soon we will

here the Jan. reimbursement got delayed by Y2K or other such computer glitch?

It is encouraging to see that we have some fighters out there, what we

have is worth fighting for, but is sure making an old man out of me. ha

Happy New Year.

A. Towne, PT

[Guest guest]

Hi, Barry:

That Reception should be a hoot --- if your sense of humor is strong and

ironic.

The discussion probably will be more " they talk " and " you listen " .

We shall all be eager to hear about your adventures.

Lucy Buckley PT

[Guest guest]

Hi ,

As always thanks for your insight!Last week I received an invitation

from Oxford Health Plans inviting me to a Reception to dicuss the new

" Therapy Services Program " on Feb 3, 6-8P.M. in Saddlebrook,N.J. Anyone

going to attend? Please let me know.Should be an interesting meeting!

Barry G. Inglett,P.T.

Wayne P.T. & Spie Center

atown-@... wrote:

original article:/group/ptmanager/?start=9508

> Dear Barry and all:

>

> Having followed all the traffic on the ever increasing

reimbursement

> crunch we all seem to find ourselves I find it difficult to remain

merely a

> " lurker. "

>

> Oxford seems to be just another third party payer who has

incorporated

> one of the newest " dodges " to restrict our services to legitimate

patient

> care. The " ruse " of requiring a new precert for treatment is very

similar to

> tactics we have experienced here in Ohio with different payers. Our

problem

> with the delay and inconvenience to the patient is that most of our

patients

> are not upset, even when we explain that it is their insurance

company that

> is causing the problem. I would have to agree with Ken when he said

that the

> payers have organizations and associations to which they belong. If

we are

> still so naive to think that they are not " discussing " reimbursement

> strategies then we should be ashamed. This is one concern I have

addressed

> on numerous occasions with our National reimbursement dept. If we

had a

> central clearing house that received the changing tactics by the

payers

> perhaps we could address the growing trend of new crunches that

certainly

> hits at the pay windows of the private practitioners on an almost

daily

> occurrence. From what I cannot gather, however, is the same thing

happening

> to OP PT at the hospitals, or with other providers? If not, then can

there

> be some legal action considered for discrimination?

> As for the coverage issue, we have had occasions where the " so

called

> treatment " is covered, it just isn't reimbursed according to the

rules that

> the payer elects to pay. Similar to what Oxford appears to be

saying.

> Barry, if you are indeed giving treatment anyway with that initial

visit then

> they are winning and we are falling into their well conceived plan to

deny

> payment and the patient becomes satisfied, not because their coverage

was

> good but because you were so benevolent. It is my humble opinion

that we

> have done this since the inception of Medicare if not before and we

are not

> making the smart " business " decision because we are less business and

more

> patient oriented. I have staff who continue to give the store away

and in

> the end it costs jobs and practices. I get really exercised by the

fact that

> I can no longer run my practice the way I want to run it. That being

the

> case then one has to follow the rules tightly and demand that the

same rules

> apply across the board. Here is where I think our association has to

adopt a

> change in philosophy. If we have to do it then everybody must play

by the

> same rules and we all know that the payers are creating new

" interpretations "

> and saving lots of bucks in the meantime. In the end the patients

are

> shortchanged and we continue to experience higher practice costs and

lower

> reimbursement.

> I applaud Rick's efforts, we are doing similar activities through

our

> state network. Overall, I think we need a much more harsh approach

by

> turning in the offending payers to state Insurance commissions,

report all

> plan interpretations to your state legislators and Medicare/Medicaid

plans to

> your federal legislators, and keep copies and send them to our

association.

> I don't think we can win this one by ourselves, this is growing and

we

> haven't the resources to outlast the payer community.

> In closing, I do not believe for a moment that payers are

independently

> conceiving these new payer schemes on their own. I quit believing in

the

> tooth fairy a long time ago. How long do we want to bet on how soon

we will

> here the Jan. reimbursement got delayed by Y2K or other such computer

glitch?

> It is encouraging to see that we have some fighters out there,

what we

> have is worth fighting for, but is sure making an old man out of me.

ha

>

> Happy New Year.

>

> A. Towne, PT

[Guest guest]

Barry:

I'm unable to attend the Saddlebrook meeting due to CSM, however, there is

another meeting in Westchester on Monday evening, 31 January. We'll be

attending that meeting.

Elmer Platz, PT

T/A Vernon Orthopaedic & Sports PT

418 Route 515

Vernon, NJ 07462-3027

fax

www.platzpt.com

" Every man owes part of his time and money to the business

or industry in which he is engaged. No man has the moral right

to withhold his support from an organization that is striving

to improve conditions within his sphere. "

President Theodore Roosevelt

Re: FW: Oxford and restrictive plans

Hi ,

As always thanks for your insight!Last week I received an invitation

from Oxford Health Plans inviting me to a Reception to dicuss the new

" Therapy Services Program " on Feb 3, 6-8P.M. in Saddlebrook,N.J. Anyone

going to attend? Please let me know.Should be an interesting meeting!

Barry G. Inglett,P.T.

Wayne P.T. & Spie Center

[Guest guest]

At 06:16 AM 1/10/00 -0800, you wrote:

Hi ,

As always thanks for your insight!Last week I received an invitation

from Oxford Health Plans inviting me to a Reception to dicuss the new

" Therapy Services Program " on Feb 3, 6-8P.M. in

Saddlebrook,N.J. Anyone

going to attend? Please let me know.Should be an interesting meeting!

Barry G. Inglett,P.T.

Wayne P.T. & Spie Center

Barry

They will probably just show you the menu and then not let you eat any

food at this reception <grin>

R. Kovacek, MSA, PT

Email Pkovacek@...

313 884-8920

Visit

<www.PTManager.com>

TOGETHER WE CAN MAKE A DIFFERENCE !

[Guest guest]

is this meeting openned to the public?

" elmer platz, p.t. " wrote:

original article:/group/ptmanager/?start=9513

> Barry:

>

> I'm unable to attend the Saddlebrook meeting due to CSM, however,

there is

> another meeting in Westchester on Monday evening, 31 January. We'll

be

> attending that meeting.

>

> Elmer Platz, PT

> T/A Vernon Orthopaedic & Sports PT

> 418 Route 515

> Vernon, NJ 07462-3027

>

> fax

> www.platzpt.com

>

> " Every man owes part of his time and money to the business

> or industry in which he is engaged. No man has the moral right

> to withhold his support from an organization that is striving

> to improve conditions within his sphere. "

>

> President Theodore Roosevelt

>

> Re: FW: Oxford and restrictive plans

>

>

>

> Hi ,

> As always thanks for your insight!Last week I received an invitation

> from Oxford Health Plans inviting me to a Reception to dicuss the new

> " Therapy Services Program " on Feb 3, 6-8P.M. in Saddlebrook,N.J.

Anyone

> going to attend? Please let me know.Should be an interesting meeting!

>

> Barry G. Inglett,P.T.

> Wayne P.T. & Spie Center

>

>

>

>

[Guest guest]

The following is a simulated Oxford invitation

Oxford health plans and Orthonet

would like to invite you to a reception

to discuss our new

therapy services program

Thursday, feb 3, 6-8pm

SaddleBrook Marriott

I-80 & Garden State Pkwy

Saddlebrook, N.J.

201 843-9500

please RSVP

I don't really know if you need an invite. I'm sure you can

just call and RSVP.

Sincerly,

Barry G. Inglett, P.T., Cert. MDT

N.J.License # QA 01462

original article:/group/ptmanager/?start=9523

> is this meeting openned to the public?

>

>

>

> " elmer platz, p.t. " wrote:

> original article:/group/ptmanager/?start=9513

> > Barry:

> >

> > I'm unable to attend the Saddlebrook meeting due to CSM, however,

> there is

> > another meeting in Westchester on Monday evening, 31 January. We'll

> be

> > attending that meeting.

> >

> > Elmer Platz, PT

> > T/A Vernon Orthopaedic & Sports PT

> > 418 Route 515

> > Vernon, NJ 07462-3027

> >

> > fax

> > www.platzpt.com

> >

> > " Every man owes part of his time and money to the business

> > or industry in which he is engaged. No man has the moral right

> > to withhold his support from an organization that is striving

> > to improve conditions within his sphere. "

> >

> > President Theodore Roosevelt

> >

> > Re: FW: Oxford and restrictive plans

> >

> >

> >

> > Hi ,

> > As always thanks for your insight!Last week I received an invitation

> > from Oxford Health Plans inviting me to a Reception to dicuss the

new

> > " Therapy Services Program " on Feb 3, 6-8P.M. in Saddlebrook,N.J.

> Anyone

> > going to attend? Please let me know.Should be an interesting

meeting!

> >

> > Barry G. Inglett,P.T.

> > Wayne P.T. & Spie Center

> >

> >

> >

> >

>

[Guest guest]

Dear Ken and Elmer:

I have ridden with Barry, bring your crash helmets [probably an appropriate

piece of equipment for the meeting now that I think of it] and your own food.

[grin]

We will all look forward to your multiple prospectives and reports, looks

like we will all benefit if you do attend. GOOD LUCK!

peter a. towne, I better be the lower case peter on this system.