January 18, 2010 — The American Chiropractic Association (ACA) has been made aware of managed care organizations (MCOs) issuing “non-renewal” notifications to DCs. The notifications do not indicate reasons for the non-renewal and do not offer the doctor an opportunity to appeal.
ACA believes these non-renewal notifications sometimes can be a termination in disguise. In some states (check with your state laws regarding this topic), when doctors receive a termination notice, they are provided a chance to appeal.
However, in most cases, when doctors receive a non-renewal notification, they are not given an option to appeal. Therefore, if you receive a non-renewal notification, there are still ways you can present your case to the insurer and possibly get the non-renewal rescinded.
1. Contact the insurer’s provider-relations department via phone, mail, or e-mail, requesting an explanation of the non-renewal. In your correspondence, state how long you have been a provider in good standing with the insurer, and how many patients will be affected by the decision.
2. Start a petition in your office for patients to sign. Once the petition is completed, send a copy to the insurer. Be sure the petition clearly informs patients of the purpose of the petition, how it will be used, and to whom it will be sent. Also, patients must sign the petition and should not have a proxy sign for them.
3. Contact your elected officials (such as the local congressional representative or senator), advising them of the situation. They may be able to contact the insurer on your behalf or direct you to another agency that would be better able to assist with this issue.
4. Contact an attorney to determine if you have any legal recourse, as laws vary from state to state.
It is crucial to begin these actions as soon as possible, to allow plenty of time for the various parties to review the issue and explore different avenues for appeal. ACA can also offer guidance and support on this topic. If you receive a non-renewal notification, please complete the ACA’s Insurance Inquiries form at www.acatoday.org/help and a staff member will contact you promptly.
Source: American Chiropractic Association, www.acatoday.org