Initial Experience with Five Managed Care Organizations when Requesting a copy of the Current Contracts and Fee Schedules

December 2, 2010 in Blog, Uncategorized by support Team  |  Comments Off on Initial Experience with Five Managed Care Organizations when Requesting a copy of the Current Contracts and Fee Schedules

A practice should verify their contract terms and fee schedule with the managed care organizations once a year. I was interested to see how long it would take to request this information from the top five payers of one of the practices we managed the billing and collection. Since each company has their own processes and systems, the customer experience varies between the insurance companies. In most cases, it takes time to obtain a representative. Once you are able to make contact with a Customer Service Representative the representative will usually provide you another name and number to call to obtain the information. For this particular practice, my experiences were with Aetna, Highmark, Independence Blue Cross, Cigna and Highmark and are as follows:

  1. For Aetna, I called the main number (800)624-0756 and spent 4 minutes moving through the menu options until I requested “Customer Service”. After obtaining a customer service representative, she informed me that I needed to speak with our “Network Account Manager”. She provided me a name and phone number. I called the person. She answered! Unfortunately, she was the person for Hospitals and not physician practices. This representative then informed me that I need to contact the Network Account Manager for Physician Groups in our County. I called the number that she provided and received a message stating that the number has been disconnected. I called the person back whom provided the number (less than 2 minutes) whom did not answer so I left her a message. She called me back and provided me an updated phone number. Fortunately, I was eventually able to speak with the person in our area whom is the Physician Network Account Manager. I stated that we are requesting a current copy of our contract and fee schedule. She stated that the practice does not have a contract but a “Service agreement” for over six years implying that we did not need the information. I needed to state to her that we needed a current copy of the agreement again and she agreed to send the information (stated would take three business days and she would send via e-mail).
  2. For Independence Blue Cross (IBC), I called the main number (800-Ask-Blue) and was able to speak with a Customer Service representative whom stated I needed to place this request with the Network Coordinator for PCPs. She provided me her direct phone number for which I left my name, reason for calling, name of the practice, tax id, return phone number and e-mail. I am unsure how long it will take this person to return my call.
  3. For Highmark, I called the main phone number (866)975-7290 and was able to speak with a Customer Service Representative very quickly. I informed her of my request and she stated that she needed to fill out a form with the request and would send to the Provider Relations Representative. She was unable to provide me the phone number or other information for this person (was able to provide the first and last name) and stated that the provider relations representative would call me back in 1-2 business days.
  4. For Cigna, I called the main number (888)992-4462 and after moving through a few menus obtained an option for “contracting”. The first Customer Service Representative stated that she needed to transfer me to contracting then the second person stated we could obtain the information by sending a fax request to Provider Solutions and Services at (866)463-6175. He stated that I needed to provide the name of the providers, practice name, tax id as well as stating that we need a copy of the contract and fee schedule and the department will follow-up via e-mail (with PDF file) or Fax. After the call I drafted a one page letter as he recommended and sent via fax to the number provided.
  5. For United, I called the main number (877)842-3210 at 4:40 pm. When I spoke with a Customer Service Representative, she stated that I needed to call another number and make the request. The number provided [(800)791-2067] is a voice mail box that states to leave the information you request. I left a voice mail providing my name, practice name, the information requested, the practice tax id, my phone number and e-mail. Unsure when or if I will receive a call back as well as the information since there is no person working the line or a name of a person at United to call if there are issues.

This initial process of contacting these five carriers took about an hour. Anticipate that I will need to follow-up with these insurance companies in two days if I do not receive confirmations that they will be sending the information requested.

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