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Dear CUA Members: Two very important economic issues have occurred in the past 2 weeks that may impact your ability to provide care to your patients. 1. After pressure from CMA, Blue Cross of California delayed implementation of their new fee schedule to August 6 allowing physicians contracted with their Prudent Buyer Plan time to review their proposed drastic cuts in reimbursement. Very deep discounts have been taken for many if not all urologic procedures. In most every instance, fees are well below Medicare rates (in most cases, 10-20% below or lower). Physicians from all over the state have been complaining and a hearing is now set for next week inLos Angeles before the Department of Managed Health Care. However, do not look to the state to modify Blue Cross' contracts. An article on the wide spread pain this is causing physician practices is attached; I urge you to read it. You should review your own unique practice situation to determine if these rates are economically feasible. This article is educational only; nothing in this article or our comments should be considered advice or recommendations regarding any action you might or might not take. 2. Many urologists have received notice from NHIC or PRG Schultz (the Medicare Recovery Audit Contractor) in the past 2 weeks that they have retroactively re-priced allowable fees for Lupron injections given from late 2002 through 2003 to the least costly alternative level. This has resulted in demands for repayment of more than $528 per 4 month depot injection. For many urologists, this means an immediate demand of many thousands of dollars with a threat of further demands to follow (interest at 12.375% per annum begins to accrue on any repayment not received by the date specified in the letter). Other physician specialists around California have received similar demands and we are working hard to create a defensible response to this demand. To help us coordinate our efforts, if you have received such a letter or EOB or know someone who has, please summarize your situation and forward information to the CUA. Include the number of patients involved, the dates of service, the amount per claim and total dollars demanded. Please let us know if any of the charts in question had been requested by the RAC for review prior to the demand letter. VERY IMPORTANT, please include the exact date of the first letter or EOB you received that could be construed as a demand for reimbursement. A question of statute of limitations or limits on the scope of work allowed to the RAC may resolve some of these demands. Jeffrey Kaufman MD, FACS Blue Cross Healthcare hearing in LOS ANGELES DATE: Tuesday, Aug. 7, from 10 a.m. until 3 p.m. Location: 320 West 4th St., Los Angeles (Carmel Room Auditorium at the Junipero Serra Building) Physician and consumer complaints about Blue Cross of California will be aired at a Department of Managed Health Care's hearing. In addition to physicians' complaints, regulators are expected to take testimony from the public about premium increases, retroactive cancellation of individual coverage after a serious illness and the level of corporate profit, including a recent payment of $950 million by Blue Cross of California to WellPoint Inc., its corporate parent. For more information or to submit comments to state regulators, contact Denise Schmidt at (916) 322-2078 or send an e-mail to publiccomments@dmhc.ca.gov You may also submit written comments by mail to Department of Managed Health Care, 980 9th St., Suite 500, Sacramento, CA 95814. __________________________________________________ August 7, 2007 Tuesday 10
a.m. - 3 p.m. The Department of Managed Health Care (DMHC), which regulates health care service plans in California, has scheduled a public meeting to examine the Undertakings and related issues regarding Blue Cross of California that have arisen since the 2004 Anthem-WellPoint change in control. This notice and agenda are also available on the DMHC website at www.dmhc.ca.gov , under the Upcoming Meetings section at the bottom of the Home Page. AGENDA
The public is invited to speak at the meeting. Interested parties are encouraged to file written comments on or before August 2. Please direct comments or questions to the California Department of Managed Health Care, 980 9th Street, Suite 500, Sacramento, CA 95814, Attention: Denise Schmidt (916) 322-2078, or by email to publiccomments@dmhc.ca.gov; or by fax to (916) 322-2579. Those submitting written comments prior to the August 2 written comment deadline will be given priority to speak at the public meeting. To allow time for all members of the public to speak, comments will be limited to the subject of the meeting and may be limited to no more than five minutes in length. Reasonable accommodations for those with disabilities are available upon request. Requests may be sent via email to hdevine@dmhc.ca.gov , or call (213) 576-1386, or call California Relay CULMULATED
LA TIMES ARTICLES CALIFORNIA
DEPT. OF INSURANCE BC
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