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History of Project FAIR
Project FAIR (Focused Advocacy for Insurance Reform) was created
by the OPA, and initially funded in large part by the APA to address
the mounting concerns psychologists had with managed care and insurance
company problems. Glenn Karr, an attorney who had been volunteering with the
OPA, was instrumental in putting the Project FAIR proposal together. He
stayed in that role until 2003.
One of the first problems FAIR tackled was Anthem Insurance's
failure to provide proper notification of the psychologists' rate
change. Anthem denied any liability, but agreed to pay to psychologists
and other mental health care workers over $400,000 to settle the
dispute.
Another major problem FAIR addressed was with QualChoice, an HMO
operating in the Cleveland area. Their payments to psychologists were
lagging months behind. Through extremely tough negotiations, and using
the Prompt Pay Law, which requires payment within 24 days after receipt
of a completed claim as a threat, OPA negotiated a six-month extension
of existing rates to be paid to psychologists, which had been cut by
every other carrier in the Cleveland area. QualChoice also agreed to add
an OPA recommended psychologist to their Provider Relations Committee,
and as a result the OPA at least has some input to decisions when they are
being formulated.
FAIR, with funding from APA, also conducted an analysis of OPA
member claims. The data was instrumental in the passage of SB4 in
the 124th General Assembly. This law establishes
effective claim processing systems and requires payment of clean claims
in 30 days.It has proven to be a major improvement over the previous
legislation governing payment to health care providers.
The Mission of Project FAIR
Insurance Troubles? Here's What You Can Do
The Department of Insurance wants to hear from psychologists about problems with insurers. They
report receiving few formal complaints from psychologists. The Department has jurisdiction over companies that are regulated by the state of Ohio.
Some self-insured companies do not have to follow Ohio law because of the ERISA exemption. (After the federal parity law goes into effect on Jan. 10, 2010, there will be fewer exemptions for self-insured companies regarding mental health coverage.)
The Ohio legislature, with help from OPA's advocacy efforts, gave the Department of Insurance the right to enforce complaints against insurers in two areas:
1) Prompt Pay Complaints (requires insurers to pay clean claims in 30 days or pay interest). Read the FAQs on the Prompt Pay Law for more information.
Please send copies of your filed complaints to the OPA, so that we can document the problems.
The Goals of Project FAIR
- Influence policy
- Advocate for the highest possible reimbursement rates for psychologists
- Advocate for less paper work
- Advocate for less utilization review
- Improve protections of patient confidentiality
- Serve as a buffer between psychologists and MCOs, advocating changes without putting individual psychologists at risk
- Increase the percentage of health care dollars spent on psychological care
- Identify patterns and practices which may represent legal or regulatory abuse by individual insurance companies or MCO's
- Advocate on behalf of members to resolve problems with insurers
- Keep members informed about insurers in Ohio
The Issues
- Access to treatment is limited
- Patients have little choice of which provider they may see
- Access to membership on panels is limited
- Ethical dilemmas about quality care confront psychologists daily
- Reimbursement rates are falling
- Patient confidentiality is frequently compromised
- Paperwork is growing
Your Role