Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 Hi All, Does anyone have recommednations for getting on closed insurance providers. I practice in Seattle, and two of the biggest insurance providers have closed their panels to acupuncturists. I have noticed those on the plans are doing quite well, while those who are not (new graduates in the last 5 years) are often struggling. Any thoughts on how I can get on? Is this is legal issue? Can I hire a lawyer to help me get on? It doesnt seem like I can force them into a contract legally, but I thought I'd inquire. Thanks for any help you can offer. David Vitello, LAc Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 25, 2009 Report Share Posted August 25, 2009 David, if a participating provider asks on your behalf because you are sharing office space and s/he wants to share the client load, they will usually approve you. I had a hard time with Kaiser; I basically called every 3 month to indicate my interest, and tried to get to know the person who sends out the applications. I also had friend who were Kaiser clients call, and request that my name be added. It took about 18 months, but one day the application was there! And what a difference it has made, I see about 12 to 15 Kaiser clients a week now and have an overall good experience with them. About 30% of all Oregonians are insured through Kaiser, you can't really do well without participation unless you are a low-cost clinic. I would definitely NOT take a lawyer, they are not obliged to enlist you. Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - dmvitello01 Chinese Medicine Tuesday, August 25, 2009 2:23 PM Getting On Closed Insurance Plans Hi All, Does anyone have recommednations for getting on closed insurance providers. I practice in Seattle, and two of the biggest insurance providers have closed their panels to acupuncturists. I have noticed those on the plans are doing quite well, while those who are not (new graduates in the last 5 years) are often struggling. Any thoughts on how I can get on? Is this is legal issue? Can I hire a lawyer to help me get on? It doesnt seem like I can force them into a contract legally, but I thought I'd inquire. Thanks for any help you can offer. David Vitello, LAc Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2009 Report Share Posted August 26, 2009 What are the criteria for blocking new acupuncturists? Do they have an antitrust relationship with the old practitioners? - " dmvitello01 " <dmvitello <Chinese Medicine > Tuesday, August 25, 2009 2:23 PM Getting On Closed Insurance Plans > Hi All, > > Does anyone have recommednations for getting on closed insurance > providers. I practice in Seattle, and two of the biggest insurance > providers have closed their panels to acupuncturists. I have noticed those > on the plans are doing quite well, while those who are not (new graduates > in the last 5 years) are often struggling. > > Any thoughts on how I can get on? Is this is legal issue? Can I hire a > lawyer to help me get on? It doesnt seem like I can force them into a > contract legally, but I thought I'd inquire. > > Thanks for any help you can offer. > > David Vitello, LAc > > > > > --- > > Subscribe to the free online journal for TCM at Times > http://www.chinesemedicinetimes.com > > Help build the world's largest online encyclopedia for Chinese medicine > and acupuncture, click, http://www.chinesemedicinetimes.com/wiki/CMTpedia > > > and adjust > accordingly. > > Messages are the property of the author. Any duplication outside the group > requires prior permission from the author. > > Please consider the environment and only print this message if absolutely > necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2009 Report Share Posted August 26, 2009 They block new practitioners by saying that the " business need in certain areas have been maximized " . Basically, they limit the number of practitioners in an area code. This is really good for the practitioners on the plans because it limits their competition. Chinese Medicine , " Mercurius Trismegistus " <magisterium_magnum wrote: > > What are the criteria for blocking new acupuncturists? Do they have an > antitrust relationship with the old practitioners? > > > > > - > " dmvitello01 " <dmvitello > <Chinese Medicine > > Tuesday, August 25, 2009 2:23 PM > Getting On Closed Insurance Plans > > > > Hi All, > > > > Does anyone have recommednations for getting on closed insurance > > providers. I practice in Seattle, and two of the biggest insurance > > providers have closed their panels to acupuncturists. I have noticed those > > on the plans are doing quite well, while those who are not (new graduates > > in the last 5 years) are often struggling. > > > > Any thoughts on how I can get on? Is this is legal issue? Can I hire a > > lawyer to help me get on? It doesnt seem like I can force them into a > > contract legally, but I thought I'd inquire. > > > > Thanks for any help you can offer. > > > > David Vitello, LAc > > > > > > > > > > --- > > > > Subscribe to the free online journal for TCM at Times > > http://www.chinesemedicinetimes.com > > > > Help build the world's largest online encyclopedia for Chinese medicine > > and acupuncture, click, http://www.chinesemedicinetimes.com/wiki/CMTpedia > > > > > > and adjust > > accordingly. > > > > Messages are the property of the author. Any duplication outside the group > > requires prior permission from the author. > > > > Please consider the environment and only print this message if absolutely > > necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2009 Report Share Posted August 26, 2009 Angela, I am on the referral list for the Kaiser pain clinic, going through American Specialty Health. Are you?talking??about patients other than these? ??????????????????????????????????? Beata ?????????????????? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 26, 2009 Report Share Posted August 26, 2009 yes, there is a Kaiser panel you can join. If the client has a CHP benefit plan, they can see you as they wish, without CHP they need a referral from their Kaiser MD, however, the MD can only refer to a provider on the panel. The fees are pretty good, considerable above ASH. I am in Oregon, it might be different in other states; actually I know for sure that Kaiser worked differently in Colorado. here is a link to look at http://www.chpgroup.com/ Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - coastacu Chinese Medicine Wednesday, August 26, 2009 3:32 PM Re: Getting On Closed Insurance Plans Angela, I am on the referral list for the Kaiser pain clinic, going through American Specialty Health. Are you?talking??about patients other than these? ??????????????????????????????????? Beata ?????????????????? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 That does sound like a grey area. I'll ask around about that. - " dmvitello01 " <dmvitello <Chinese Medicine > Wednesday, August 26, 2009 2:29 PM Re: Getting On Closed Insurance Plans > They block new practitioners by saying that the " business need in certain > areas have been maximized " . Basically, they limit the number of > practitioners in an area code. > > This is really good for the practitioners on the plans because it limits > their competition. > > > > Chinese Medicine , " Mercurius > Trismegistus " <magisterium_magnum wrote: >> >> What are the criteria for blocking new acupuncturists? Do they have an >> antitrust relationship with the old practitioners? >> >> >> >> >> - >> " dmvitello01 " <dmvitello >> <Chinese Medicine > >> Tuesday, August 25, 2009 2:23 PM >> Getting On Closed Insurance Plans >> >> >> > Hi All, >> > >> > Does anyone have recommednations for getting on closed insurance >> > providers. I practice in Seattle, and two of the biggest insurance >> > providers have closed their panels to acupuncturists. I have noticed >> > those >> > on the plans are doing quite well, while those who are not (new >> > graduates >> > in the last 5 years) are often struggling. >> > >> > Any thoughts on how I can get on? Is this is legal issue? Can I hire a >> > lawyer to help me get on? It doesnt seem like I can force them into a >> > contract legally, but I thought I'd inquire. >> > >> > Thanks for any help you can offer. >> > >> > David Vitello, LAc >> > >> > >> > >> > >> > --- >> > >> > Subscribe to the free online journal for TCM at Times >> > http://www.chinesemedicinetimes.com >> > >> > Help build the world's largest online encyclopedia for Chinese medicine >> > and acupuncture, click, >> > http://www.chinesemedicinetimes.com/wiki/CMTpedia >> > >> > >> > and >> > adjust >> > accordingly. >> > >> > Messages are the property of the author. Any duplication outside the >> > group >> > requires prior permission from the author. >> > >> > Please consider the environment and only print this message if >> > absolutely >> > necessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Thanks Angela. I checked it out - Kaiser does?this only in Oregon and Washington. ??????? Now, if I could only figure out how to get rid of the darned question marks..... ????????????????????? Beata Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.