Premier Healthcare Exchange contract

[Guest guest]

I have a decision to make that I never expected. As solo PT in private

practice,I have been sent a contractual agreement between my practice and

Premier Healthcare Exchange Inc. who represents a healthcare plan who refused

in-network status to my practice. I have one client/family in which the father

is an employee of the local hospital and their medical plan coverage for PT is

through a healthcare plan managed by OSU Health Plan. I tried for two weeks to

gain in-network status. The denial was " we have enough of your provider type in

your area " . So I have been submitting claims out of network to the payer. Now

that the family has met their deductible, this intermediary (PHX) has sent me a

contractual agreement to accept 70% of billed charges with four other points in

the contract. The claims associate of PHX explained the points of the contract

but was reluctant to say what I get paid for claims if I do not sign the

contract. Has anyone been faced with such experience or decision?

Casady PT

Gaitway Therapy LLC

Belle Center Ohio