This was actually a comment on one of my posts relating to the new Tri-Care contracts. As you can see the reader is asking for any comments here so if anyone has anything to add, please feel free. In reference to the physician losing their status with United, there could be a number of reasons and
usually it comes down to contracted rates, although there could be other items as well involved. The physician’s office may not be accepting the rates of compensation possibly with his current patient mix, thus would incur a loss, so perhaps negotiations are in the working. Recently I had and MD tell me his compensation was reduced by 12% from the carrier and again that is a statement with no additional facts.
I would stay in touch with your physician and perhaps call the Tri-Care administrator for more information, I know frustrating and there may not be a definitive answer as of yet. In the related reading below there is also a post about Tri-Care using telehealth which may or may not be in your area and perhaps this could be an option in his contract to provide this type of service. Also in the news in the last day is a rebranding effort being done for current patients enrolled under Pacificare, which United bought about 4 years ago. It sounds like there’s a lot going on at one time with a large number of changes taking place due to new contracts. BD
United HealthCare Rebranding PacifiCare Name
“We are Military Retired with TRICARE Prime insurance. We understand that United HealthCare now has the TRICARE contract which starts 01 April 2010. Our Physician relayed to us on Tuesday, 20 October that his office May lose their provider status under United and no longer be able to carry TRICARE insurance. He told us that they are fighting to stay as a provider but could lose the battle. We are more than 200 miles away from a MTC and don't understand how this could happen. It now appears that providers must have a huge population of military retirees before being allowed to have TRICARE as an insurance. Comments????? “
Related Reading:
Tri-Care Giving Telehealth Services a Try
Aetna and United Healthcare Secure Military Contracts
Unitedhealth receives $21.8b military health care contract with ...
FYI -- The federal government sets the reimbursement rates. It doesn't matter what insurance company is managing the TRICARE contract -- they have no power to change the amount paid to the docs. It's a straight pass-through. The contract changes over in late 2010 (not April). Reimbursement rates are based on the federal fiscal year and whatever the government has determined them to be.
ReplyDeleteThanks for adding the information on Tri-Care, appreciated.
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