Follow-up to December 2, 2010 Experience with Five Managed Care Organizations (Aetna, IBC, Highmark, Cigna, United Healthcare)

December 23, 2010 in Uncategorized by support Team  |  Comments Off on Follow-up to December 2, 2010 Experience with Five Managed Care Organizations (Aetna, IBC, Highmark, Cigna, United Healthcare)

It has been about three weeks since I contacted the top five managed care organizations for a customer of ours. The purpose of my initial call was to obtain their current agreement and fee schedule for their top five payers. I started as if I had no experience or contacts in the field to see how long it would take to obtain the proper information. Here is the update by managed care plan:

  1. Aetna: The Physician Network Account Manager on 12/2/10 stated that I would receive the information via e-mail within 3 business days. I called at the end of the third business day to check on the status. She did not call me back until I called again and sent and an e-mail to her as a follow-up (10 business days after our original call). After some further back and forth via e-mail (few hours), I was able to obtain a copy of the agreement as well as fee schedule.
  2. IBC: Independent Blue Cross (IBC) – the office had to request the information, sign a document, follow-up with the representative. IBC provided the agreement and fee schedule by 12/17/10.
  3. Highmark: The most disappointing of the five carriers. After a few phone calls and e-mails the network representative provided a general mailbox (estprovcred@highmark.com) for contract and fee schedule requests. She stated would only take 1-2 business days. I followed up after 10 business days and still have no response or information. The Network Representative is out of the office from 12/23/10 until 1/3/11 due to the holidays. I left a message and will need to follow-up again in a few weeks.
  4. Cigna: The representatives (888-992-4462) stated there is no provider representative and could only provide a fax for this information. Cigna would not expect a Pediatric Office to not provide the name of their doctors or not to provide the location of their doctors when they need help, why do they avoid their providers when requesting simple information related to contracting? The woman on the phone stated that we need to send an urgent fax (866-463-6175) and that there might be a provider representative that would call us back. We sent the fax, as instructed, 10 business days ago, no one called as of yet. Today, at the main number, they instructed me to send another fax to the same number.
  5. United Healthcare: The Network Manager (obtained proper information by calling 877-842-3210) was good at providing the fee schedule and initial follow-up. He was available we I called or followed-up within a few days. There were a few additional codes missing from the fee schedule for which I requested the information and he was able to obtain after a telephone call.

The commitment to follow-up on contractual items is very inconsistent with the Health Plans (even if the representative states they will follow-up). Due to this, the burden of follow-up is on the provider’s office or the company that works for the provider’s office.

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