Re: CO-PAY REDUCTION DICTATED BY INSURANCE

August 4, 2005

Diane

A couple of comments about your United Healthcare issues:

1. An organization is the most logical way to fight United Healthcare.

2. Any time an HMO/Insurer dramatically infringes on a patient's right to

healthcare, it can land on the front page of the local newspaper or the

opening story of a newscast.

3. If you are able to identify patients that receive substandard care, if

you are able to find a media outlet that can report it, it makes for a good

story.

4. There are relatively new insurance plans with Health Savings Accounts

associated with them that take coverage out of the insurance industry's hands

and places it back in the consumer's hands. Unfortunately, people who

purchase insurance coverage are not demanding this coverage. As a healthcare

provider, you could learn about these types of policies and recommend them to

the

people that buy policies. I know, I've had a policy similar to this for the

past 8-10 years.

5. A lot of providers don't care about what United Healthcare does because

they are not a major player in their backyard. If they are a major player in

your area, then you will need to band together with other therapists through

your state organization and possibly tie your efforts in with other state

chapters of healthcare providers (i.e., AMA, ASHA, AOTA) then go public with

your issues.

Everyone needs to be getting involved with these fights because there seem

to be more and more of them with each passing month. They range from these

types of issues to ones like insurance companies setting Medical Review policies

that are opposed to what other insurers are doing because they know not all

providers are willing to fight for their money.

Just a couple of thoughts on a Thursday Night.

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/447-5625

August 4, 2005

Hi, Diane -

Thanks for pointing up this important issue.

Someone once noted for me that insurance companies are actually financial

institutions, rather than health care institutions. Their function is to

spend less than they take in, and then divide the leftovers among the

owners. Perhaps that explains their actions.

Dick Hillyer, PT

Cape Coral, FL

CO-PAY REDUCTION DICTATED BY INSURANCE

Did anyone read the article on the front page of the Arizona Republic, dated

today, August 4th.. " Insurers Ranking Physicians in Valley " (Co-Pay Could Be

Tied to Choice of Caregiver).

According to the article, Aetna and United Healthcare are planning to RATE

physicians by the amount of money they save the insurance companies. If the

physician is successful in keeping costs down, then Aetna and UHC

will 'reward' the physicians and the patients by reducing the co-pay amount

for the patient and recommending that physician to the patient. Quality of

patient care is not an issue, just the $$$$.

We as healthcare providers will soon be affected by this as well. And we as

patients ourselves, will most definitely be affected because physicians will

be extremely frugal in choosing possibly life saving tests, medications, and

procedures for us, as patients, so that they can earn their 'reward'.

According to the article, physicians are not happy about this at all, nor

should they be.

Once Insurance companies took over as they have and put themselves in the

driver's seat, providers were pushed to the passenger side to blindly go

where the insurance companies dictated. Then they pushed us out of the car,

and ever since, we have been trying to run outside of the car, trying to

catch up with them. Now with this, they are running us over! When will

this insanity end? What is next!!

We belong to the APTA and we voice our opinion but it is obvious that too

little is being done too late. The APTA is terrific and they are doing

their best but there has to be more that we can do to get back into that

car.

If physicins are forced to meet these demands, we as therapy providers will

be as well. It is obvious that we all will have no other choice but to cut

our costs, whether it be through less trained personnel, eliminating the

purchase of more up-to-date equipment, eliminating certain modalities and

procedures for out patients, etc.

It seems that physicians and all other types of healthcare providers need to

band together in huge numbers to fight this organized crime that will bury

us all, providers and patients alike.

Diane

Valley Rehabilitation

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August 5, 2005

> 5. A lot of providers don't care about what United Healthcare

does because

> they are not a major player in their backyard. If they are a

major player in

> your area, then you will need to band together with other

therapists through

> your state organization and possibly tie your efforts in with

other state

> chapters of healthcare providers

Jim (and Dick)

Thanks so much for the insight, and thanks to the original poster

for making us aware of this issue. United might not, today, be a

big player in your area. I happen to be in a position to watch

their growth in the mid-Atlantic region and presume their intention

is to continue to purchase small to mid-sized hMo providers. The

strategy is simple... buy them out, convert them into the United

policies. Rip up the old fee schedules and create newer, more

insurance company friendly ones. I presume that their growth

initiatives are not limited to just our region, as United exists in

some form in many parts of the states.

While the outcome of this bears watching, I bet that the insurance

industry lawyers have already checked out whether they can get away

with it, with the costs (outrage by the insursed, anger by

providers, cost of prospective lawsuits) versus the benefits (not

having to cough up as much to providers) studied.

- Simonetti, PT

land

where MAMSI has been bought out by United

August 5, 2005