PT/OT/SP Negotiation Group

[Guest guest]

All

For the last several years I have noted posts on this listserv about different

insurance companies that broker Unilateral contracts (which I believe can be

unenforceable if challenged in a court of law-but I am not an attorney and would

look forward to hearing one comment on this thread). While most providers want

to be in network with an insurer, most of the contracts offer poor reimbursement

at best and some even pay less than the cost of the services provided.

Typically the terms are one sided in favor of the insurer and many providers

feel they have to accept those terms because they don't want to lose a

good/strong/potential/fill in the blank referral source. Additionally, these

contracts roll in perpetuity with no rate increases.

I believe I now have the desired attention to ask the question. Has anyone

thought about forming a network of providers in a geographic region to discuss

how to deal with these insurers? I know the next post will be screaming

collusion or monopoly, but if you joined a group and paid a minimal fee then

teleconferenced via Skype, Go To Meeting or some other medium, I believe being a

member of this group/community would effectively remove the collusion/monopoly

argument. Besides, banding together in such a way gets you closer to being on

equal negotiating footing with the payer.

If PT's, OT's and SP's wanted to do this, I think the best way to accomplish

this would be by state, since state laws would govern where a clinic is located.

I would suggest that the northeastern part of the United States would be ripe

for something like this, since managed care and lawmakers have set fee schedules

at artificially low reimbursement rates and held them there for years.

In order to do things in an appropriate manner, I would recommend that a group

have the ear of an attorney from an initial phase. I remember hearing

Brodek discuss contracts at PPS in DC last fall and believe someone like him

might be good to have in the mix fairly early.

I will get off the stump now to see if this post hits a nerve.

Just trying to stir the pot,

Jim <///><

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