We have had a good couple of weeks with Insurance activity. Below is a breakdown on happenings with each payer.
Aetna – The OSCA has been receiving complaints about Aetna’s denials for medical necessity. We have successfully acquired all of the supporting evidence to state our case and will be meeting with Aetna by the end of the month.
Ohio Health Choice – We are continuing our conversation with them. They are helping us understand why providers in the Columbus area are not being viewed as In-Network with NGS/Coresource. We are looking for providers to help supply us with the evidence to support our position.
Custom Design Benefits – This connection has been put on hold until we can finalize the relationship with HealthSpan. CDB is connected to them already and felt that having a direct relationship outside of HealthSpan would create issues later. Our team agreed and we will be working with HealthSpan to make this happen. – No New Update
HealthSpan – Our meeting on February 12th has been canceled. We are being told to reach out to them in the second quarter. We will continue to reach out and hope we can have a better response from them in the 2nd quarter.
Care Source – We held our meeting on January 27th and it proved to be VERY successful. We met with them for over an hour and a half. We had the opportunity to dig deep in the details of the proposed pilot program and are confident that they are ready to move. We will have a follow-up call with them the first week of March. We are hoping the new start date for the pilot will be July 1st. We discussed extensively the importance of allowing our providers to do what they are trained to do and to compensate them for it. At this point we seem to be on the same page. We are VERY excited about the progress here.
Paramount / ProMedica- The meeting scheduled for January 19th has been rescheduled for February 16. – No New Update
Molina – Still trying to rekindle these talks. Still not sure what causes them to stop communicating. – No New Update
MMO – We have been corresponding with MMO through email and are setting up a date for March 2nd.