“We assist the physician by compiling the necessary evidence, and writing the necessary appeal letters, all in the effort of convincing the health insurance company of one simple fact: it is in their best financial interest not to drop this particular physician from their insurance network.“
The Affordable Care Act (“ACA”), lovingly titled “Obamacare” by the masses, is not only changing the relationship between health insurance companies and consumers, but also between health insurance companies and the physicians who eventually treat those consumers as patients.
While the effects and intricacies of the Affordable Car Act are vast, and “experts” often like to argue about what the effects will be, there are a few immediate consequences that are noticeable. One of these consequences is that health insurance companies are dropping physicians from their participating physician networks. On the more drastic side, we see consequences such as Aetna not participating in the Connecticut Health Exchange.
These health insurance companies are also dropping thousands of individual physicians. The health insurance companies cancel physician participation without cause or reason. Most of the contracts that physicians sign in order to participate with these insurance plans have clauses allowing the insurance company to cancel network participation, in writing, within a certain period of time. They do not need to give a reason, at that point it simply becomes a contractual right. All they need to do, and all they actually do, is send a letter to the physician in the mail canceling physician participation after a certain date.
But there is hope. Most of the original participation contracts, the same ones giving the health insurance company a right to cancel physician participation, also award the physician the right to appeal the decision of the health insurance company to cancel physician participation.
Sadly, these contracts do not include, and insurance companies will not tell, exactly what they are looking for in a network cancellation appeal. This may also be because there is no set criteria, just a totality of the circumstances approach.
This is where the Law Office of Eugene Glouzgal can help physicians in their struggle against the ever growing power of the health insurance companies. We can help physicians appeal the health insurance network cancellations. We assist the physician by compiling the necessary evidence, and writing the necessary appeal letters, all in the effort of convincing the health insurance company of one simple fact: it is in their best financial interest not to drop this particular physician from their insurance network.
If you are a physician who has recently been dropped from a health network by a health insurance company, let the Law Office of Eugene Glouzgal help you file an appeal that stands a chance of being considered by the health insurance company. Contact us today.