A Very Busy Year for Project FAIR

The mission of Project FAIR (Focused Advocacy for Insurance Reform) is to analyze the practices of insurance companies and MCOs in Ohio, identify patterns of abuse, address the problems and abuses directly with the insurance companies and MCOs and refer insurance practices violations to appropriate regulatory agencies, if necessary.

2012 has been a very busy year for our work under Project FAIR.

  • The Federal Parity Law give us new options and we are watching the process of law suits around the country that have a bearing on the issues we are finding in Ohio.
  • We are in regular contact with APA’s Legal and Regulatory Affairs Office.
  • Our biggest problems this year were with Humana and their behavioral health carve out, LifeSynch.
  • OPA member’s complaints to the Ohio Department of Insurance have shined a bright light on LifeSynch’s unprofessional behavior.
  • Anthem: We continue to deal with issues relating to their requirements for prior ‘notification’ of treatment. We anticipate that Anthem will be changing the procedures soon.
  • Medicare: A tough year of transition from one to another to another provider, on top of the CMS directed recertification process hitting Ohio psychologists.
  1. The 5% fee cut is a serious problem for all Medicare providers. OPA has used some of our national contacts to work on the fee and recertification issues.
  2. Representatives from our Insurance Committee are working to set up a meeting with the Medicare Medical Director.
  3. A Medicare workshop is in the planning stages now.
  • Medicaid: OPA has been working with Ohio’s Office of Health Transformation, the Medicaid Director for Ohio and the departments that have a relationship with Medicaid to stay on top of an evolving situation.
  1. The Director of the Office of Health Transformation will speak at our Legislative Day.
  2. Medicaid managed care is back and OPA and its coalition partners are trying to be sure there is consistency around Ohio in coverage and processes.
  • With our partners in the Provider Coalition, we are advocating for SB136, which addresses ongoing contracting issues with third party payers, shortens the prompt pay payment period for electronic claims to 15 days and limits how far back insurers can go to take back paid claims to six months.

Much of our Project FAIR work is done in conjunction with the OPA Insurance Committee. If you would be interested in being part of this committee please email Michael Ranney.

FAIR is funded by a combination of dues and donations from members. Our goal is to raise $8,500 and to date members have contributed just over $3,000. We appreciate your support of this special advocacy program.

 

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