Cigna, WellPoint questioned over blended rates

Doctors met with WellPoint and sent a letter to Cigna in an attempt to rescind policies that treat multiple levels of codes as one category.

By Jonathan G. Bethely — Posted April 10, 2006

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Physicians concerned about unfair payment practices by two major insurers have called for an end to blended rate payment policies.

The American Academy of Family Physicians, along with several other medical specialty associations, sent a letter to Cigna's northeast regional office in February calling on the insurer to end its blended rate policy, which treats procedures with CPT codes levels 3 through 5 as one level for physicians in the New York City area.

Meanwhile in Ohio, physicians, including representatives from the American Medical Association and the AAFP, recently met with WellPoint executives to address a blended rate payment policy that combines level 3 and level 4 codes under one category.

In each case, physicians are upset the plans have responded to their greater sophistication and accuracy in coding by blending higher level rates.

"Really it's saying, 'We don't care if it's more work involved. We're just going to pay one rate,' " said Trevor Stone, private sector advocacy specialist for AAFP. "That just contradicts the whole idea that the amount of resources and work is actually greater than a level 3."

The letter to Cigna, dated Feb. 24, calls for the company to provide proper education to physicians the company believes are coding incorrectly but suggests Cigna "should not compromise the correct coding of all physicians for the perceived problems of a minority."

Stone said he hasn't heard back from Cigna executives, but he plans to follow up the letter with a phone call. He said he hopes to meet with Cigna executives to discuss the situation.

"I'm actually a little surprised," Stone said "I thought they would have responded by now."

When asked about the AAFP's letter to Cigna, company spokesman Wendell Potter said the insurer would "gladly meet with doctors to discuss the very localized program." He said the company has no plans to expand the program beyond the New York region.

Meanwhile, in a March 24 meeting attended by WellPoint executives and physicians' associations, including the AMA, the parties established a timetable of meetings to address doctors' concerns.

Physicians asked WellPoint to rescind the blended rate policy and make whole those physicians who lost income as a result. Physicians also are asking WellPoint to agree to a consistent policy regarding electronic medical records.

"We believe that the blending of rates is tantamount to downcoding," said Ameta E. Cooper, general counsel for the Ohio State Medical Assn. "Physicians should be paid for the level of complexity that they provide."

Cooper said another meeting is scheduled in three weeks. But WellPoint has said it has no plans to drop its blended rate plan in Ohio. It said the plan actually pays physicians more than they made before, because the reimbursement rate is higher than the previous level 3 rate.

WellPoint also has said it has no plans to expand its blended rate plan elsewhere.

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