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Ups and Downs

An alternative title for today’s posting might have been: “I hate insurance companies” and that is why I gave it some time before I actually recapped today’s events.  Truth be told, most everyone working at the Capitol are good people just doing their jobs.  So if we have a bill that is trying to tie the hands of insurance companies to prevent abusive recoupment practices, they will push back saying they need the freedom to collect money from those physicians who are acting fraudulently.  Although just a few days ago it appeared as if we were close to an agreement, today many who we worked out “agreements with” decided to instead renew their opposition.

After weeks of facilitating the negotiations between providers and insurers, it was decided today that we had reached an impasse.  Although we had worked out agreements with a large number of issues with our recoupment reform, the insurers informed us that they wanted the ability to exempt themselves from the 18 month time limit any time they “believed” there was misrepresentation.  We instead demanded adjudication by a third party so that the insurer would have to actually prove fraud to recollect funds beyond the 18 month. We will be making our case before the committee and work to get the legislators to side with us in the matter.

For some better news, Representative Phelps has agreed to carry our oxygen bill for us in the House after it passes the Senate.  Its always important to have a friendly legislator ready to catch a bill when it comes over from the other chamber, or else you could find you bill gutted or in the hands of a hostile sponsor.  Also, the Medical Practice Act rewrite (SB1540) passed out of committee today containing our oxygen language as well.  We are hoping for both of these bills to move to 3rd reading and a Senate vote very soon.

Here’s an article profiling one of our doctors and his usage of oxygen therapy in his office.  Sadly, this very article alerted the Department of Professional Regulation and subsequently the disciplinary board.  This is one of the many issues we are hoping to fix with our proposed oxygen bill.

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