With hundreds of HMOs and PPOs in business, there are many opportunities for physicians to participate with myriad managed care plans. Not all of these opportunities are good ones, however. How does a physician group know which plans to avoid and which to join? Does the plan offer competitive fees? Does the plan have the patient volume to support the discounts it seeks? Or is it selling physician discounts to payors without bringing patient volume in return? Women's Health Connecticut's Managed Care Department has the expertise to help physicians sort through the key issues to determine which plans are critical to the physician's bottom line, -- and which plans will only reduce the bottom line.
In today's market, physicians need a partner to help level the playing field. Often, managed care representatives will claim that their plan does not negotiate. To an extent, that's true…plans have no need to negotiate with anyone who will accept that response as the plan's final answer. Physicians often do not have the resources needed to push for something better. Women's Health Connecticut's Managed Care Department can provide those resources. Since our inception, we have successfully negotiated fee increases of 5-20%, even with plans that "do not negotiate."
Negotiating fee increases is not our only strength. After all, a fee increase is worthless if a physician group cannot collect payment on the services you provide. Women's Health Connecticut's Managed Care Department scrutinizes the contract language to identify any clauses that may be harmful to the physician, and then to negotiate the changes necessary to protect the physician's interests. Will the physician be compensated for services rendered while in credentialing? Can the plan reduce the fee schedule without the physician's knowledge? Is the plan required to pay the physician within a specific timeframe and if they don't, what is the physician's recourse? The managed care plans ensure that their interests are protected through the contract language, and so should physicians.
The following represents a list of managed care plans with whom we have worked:
- Aetna US Healthcare
- Anthem Blue Cross and Blue Shield
- ChoiceCare
- CIGNA
- Community Health Network
- ConnectiCare
- First Health
- GHI
- Healthcare Value Management
- Health Net
- Health Network America
- HMC
- Managed Care Strategies
- MultiPlan
- Northeast Health Direct
- One Health Plan
- Oxford Health Plans
- Pioneer Health Network
- Private Health Care Systems
- SelectPro
- United Healthcare
For more information about our services and value to physicians, please click here.
