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Insurance night mare

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  • Insurance night mare

    I will attempt to summarize logically.
    I am a Physical Therapist in Ohio. The State Law does and has for the past 40 years allowed us to employ trained aids in our clinics to assist us with duties that are mundane and repetitive. These aids are under our direct and immediate supervision at all times. They perform routine duties that would basically waste the time of the physical therapist and deteriorate proper care to the patient.
    The insurance industry in their desire to put more and more clinics out of business, has declared that the work done by the aids must be free. They have paid for the services of aids for the past 50 years with no problem.
    The clinics provide equipment, space etc etc. and have significant costs associated with them. The insurance industry is trying to say "TOO BAD"
    eat the costs. Medicare is included in this newest attack as well.
    So far there has been no actual denial of payment based on this, but it will eventually happen. They have no real method to enforce this, but the threat is always there.
    I own operate and maintain my building, I own the equipment etc. etc. I am expected to realize a return on my expenses. etc. etc.
    Here is the kicker!! The insurance industry forces us to sign contracts for care that is 50% of our fees. If we don't sign these contracts, we cannot take their patients. If we don't sign, we have no work. The contracted rate is usually 50% or our normal fee. Also the patient must pay part of the fee
    that the insurance is paying, usually 20%. The difference between our actual fee and the contract rate cannot be charged to the patient.
    How do I fight this? Where can I do research on my rights? Trained aids have been a part of our services for more than 60 years without incident. They have helped us provide excellent care and have keep the costs under control. The insurance industry in their limited intelligence sees this as a way to force many clinics to close, I believe that is their motivation for moving in this apparently counter productive and absurd direction.

  • #2
    Re: Insurance night mare

    It would seem your trade association may be the best ones to handle that on a large state-wide basis.

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