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Legal Update - 11.4.15
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United Healthcare:

We have no real update at this time but if providers are still having issues with UHC taking money out of EOB’s please contact our office.

 

Humana:

We are still waiting to hear from the court on their decision from the October court date.

 

If you are still having issues with Humana taking monies it is important that you appeal this decision.

 

OPTUM:

The OSCA and its attorneys held a phone call with the legal counsel of OPTUM on October 30th. During this call we shared our frustration and concerns with them on the slated “per diem” plan they are putting forth. We challenged them on the following points:

 

1)      They claim this change will help bring a payment model that encourages better outcomes. We disagree!

 

2)      They claim this change will be a net neutral reimbursement to providers. We disagree!

 

3)      They claim this change is consistent with other payers and payment models.  We disagree!

 

We stated our position strongly and asked for OPTUM to suspend the Nov. 1 roll out.  They would not agree to stop the roll out but did state that our arguments made sense and they would be going back to their team to consider modifications to the system.  We did state that any changes that did happen would need to be retroactive to November 1st and they agreed.

 

They stated we would have some kind of feedback on or before November 6th. We will continue to keep our members informed.

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