UNITED HEALTHCARE AND ACN GROUP

February 17, 2007

I mainly read posts and may respond here and there....I am the Mom

of Jillyan (age 5 - CHARGE). A quick update -- after heart surgery

for subaortic stenosis in 8/05 she started walking last summer after

5 years of long hard work. She also starting attending school in a

contained classroom this past fall and goes 4 days a week -- a

miracle that happened as a result of the heart surgery -- she could

only tolerate a couple of hours per day in preschool. She eats

everything and is this petite little thing that brings us joy every

day.

Now to my problem -- United Healthcare contracted with ACN group

last year to monitor their PT's and OT's. They forced both of mine

to sign contracts with ACN. I had reimbursement issues last year

but we finally got them resolved after I got involved. Now ACN is

sending my PT a letter stating that on 4/1/07 they are changing the

contract originally signed to where my PT is paid on a per diem

basis of $50 per visit. Needless to say my PT can't afford to see

me for that when they are normally reimbursed $80 per visit so they

are cancleing their contract with United. This is so unfair to

Jillyan as we have had Ruthie (our PT) in our lives for 4 years

now. They just can't fight the United machine anymore. My PT did

promise me she'd see Jillyan even if it is for free as she loves her

and wants to help her make more progress -- but I have insurance and

she should get paid for it!

Has anyone had problems with this? If so, who did you complain to?

I have read about this ACN group and they are cutting premiums based

upon no progress -- as we all know our CHARGERs progress at their

own pace -- it took Jillyan 5 years to walk -- a great

accomplishment for her -- but not good enough for them. Any

information would be appreciated. Thanks.

Huggins

Mom to Jillyan (5) and Hailey (9)

February 17, 2007

How frustrating ! I am so glad Jillyan is walking and all the hard

work has been paying off. I wish I could be of more help, but we don't deal

with things like that where I'm at. You just go to PT/ Speech/ OT/

whichever professional and it's just through the government. People can say

what they want but I love the socialized health care in Canada. We've been

very fortunate.

>

> I mainly read posts and may respond here and there....I am the Mom

> of Jillyan (age 5 - CHARGE). A quick update -- after heart surgery

> for subaortic stenosis in 8/05 she started walking last summer after

> 5 years of long hard work. She also starting attending school in a

> contained classroom this past fall and goes 4 days a week -- a

> miracle that happened as a result of the heart surgery -- she could

> only tolerate a couple of hours per day in preschool. She eats

> everything and is this petite little thing that brings us joy every

> day.

>

> Now to my problem -- United Healthcare contracted with ACN group

> last year to monitor their PT's and OT's. They forced both of mine

> to sign contracts with ACN. I had reimbursement issues last year

> but we finally got them resolved after I got involved. Now ACN is

> sending my PT a letter stating that on 4/1/07 they are changing the

> contract originally signed to where my PT is paid on a per diem

> basis of $50 per visit. Needless to say my PT can't afford to see

> me for that when they are normally reimbursed $80 per visit so they

> are cancleing their contract with United. This is so unfair to

> Jillyan as we have had Ruthie (our PT) in our lives for 4 years

> now. They just can't fight the United machine anymore. My PT did

> promise me she'd see Jillyan even if it is for free as she loves her

> and wants to help her make more progress -- but I have insurance and

> she should get paid for it!

>

> Has anyone had problems with this? If so, who did you complain to?

> I have read about this ACN group and they are cutting premiums based

> upon no progress -- as we all know our CHARGERs progress at their

> own pace -- it took Jillyan 5 years to walk -- a great

> accomplishment for her -- but not good enough for them. Any

> information would be appreciated. Thanks.

>

> Huggins

> Mom to Jillyan (5) and Hailey (9)

>

--

" It is far better to grasp the universe as it really is than to persist in

delusion, however satisfying and reassuring. " --Carl Sagan

February 17, 2007

United Health Care is on the " Bad " list for several provider groups. There have

been many cases where they have decided that they will pay one type of provider

for a particular service, but then won't pay another type of provider for the

EXACT SAME SERVICE. This happens to optometrists providing medical eye care A

LOT (the company tries to " force " the patient to go to an ophthalmologist for

services like removing a foreign body, treating an abrasion, treating glaucoma,

because the patient has to pay out of pocket if they chose to stay with the

optometrist), and I have heard of it happening to chiropractors also.

Supposedly, this is to reduce their costs. But, if you have to go to a second

provider and get a whole new exam to be evaluated and treated to something the

original provider could have done in the first place...I don't see how that

saves money.

I would file an appeal with your insurance company. Although this may not get

your PT back on the provider panel (they might not want to go back), at least

you will have your complaint in writing. Also, most insurances will reimburse

you for some of the costs if you go to a " non-participating " provider, although

you will have to file each claim yourself. If you really like this PT, you

could continue going and pay for the sessions privately (ask if there is a " time

of service discount " if you pay for each session in full on the date of

service--many medical offices do give a percentage off, because they save by not

having to pay someone to bill the claim and then wait so many weeks to finally

get paid). Then when you file the claim you can attach a letter explaining the

situation and how you are NOT pleased with losing your provider. You won't get

reimbursed the full amount of the visit (but suprisingly, you might get more

than the provider would have--that's happend

in my office a time or two when patients have submitted claims themselves).

You can also contact your state insurance commissioner. Depending on the laws

in your state, the commissioner may or may not have jurisdiction over your

company. I live in Washington State, and our commissioner does not have any

legal regulatory power over the individual market--and of course, I have an

individual policy . Sometimes even alluding to filing a complaint with the

insurance commissioner can make things happen too.

I wish you luck in your battle. I deal with insurance companies all the time

at work on the provider side, and since Evan has been born, I've unfortunately

had to deal with them on the consumer side more than I would like. I am glad we

have insurance, because my husband and I would be in incredible debt

otherwise...but the companies are still irritating. The thing to remember is

that they are in it to turn a profit--pure and simple. They aren't looking out

for your best interest, and they certainly aren't looking out for the provider.

I think the best way to get their attention is with the prospect of a big fat

fine--and that's where the insurance commissioner comes in.

(mom to Evan, 19 months)

shuggins316 wrote: