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Take it or leave it: What it's really like to deal with health plans

Posted By Administration, Tuesday, May 3, 2016

CSEPS leadership recently participated in a listening session with the Colorado Division of Insurance (DOI) Commissioner Marguerite Salazar and her boss Division of Regulatory Affairs Director Joe Neguse. Convened by the Colorado Medical Society (CMS), the purpose of the meeting was to hear first hand from physicians what they experience dealing in working with health insurance plans. CSEPS board members Alan Kimura, MD, MPH, and Ron Pelton, MD, PhD, joined about 30 other physicians in a two and a half hour session focusing on issues ranging from delayed payment, prior authorization problems, to inability to negotiate fair contracts.

“As a solo practice physician I feel unimportant to insurance companies and powerless to fight against them. I was surprised to find that even big practices feel the same way,” said Dr. Pelton.

DORA Executive Director JoeNegus and DOI CommissionerMarguerite Salazar.

The listening session was particularly opportune as the DOI is in the middle of developing new regulations regarding network adequacy, along with considering whether or not to block the proposed merger of Anthem and Cigna. The session was also a powerful reminder about the importance of active advocacy. Commissioner Salazar has agreed to convene a separate group in an attempt to address some of these issues. CSEPS is grateful to CMS for the opportunity to participate in the listening session and welcomes the chance to continuing to work on these problems in the future. Paraphrasing Benjamin Franklin, Dr. Pelton concluded that we have to hang together on this or we will continue to hang separately.


Tags:  advocacy  health plans  pay issues 

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