Dan Gottry - Blog

Dan Gottry's Blog

Wednesday, October 11, 2006

To All Who Are Following Linkia/Hanger Issue

To those that are following the Linkia/Hanger/SPS issue:

I just got a call from a rep at Linkia, trying to get me to sign an agreement with them to join the network. I asked her for some prices, and she could not give them to me until I signed the agreement. I asked her if the prices were that bad that she was embarrassed to tell me what they were, or what the problem is. Or was I being suckered into signing a contract before knowing what was in it.

She finally told me what the reimbursement for 2 codes was, and because I am probably NOT allowed to share that here on this list, I can say it was between 35% and 40% BELOW medicare in my state. I congratulated her for getting the prize for being one of the lowest payers in the state, even below MEDICAID!!! And, then to top that off, they would only pay the 80% of the allowed, if that was the patients benefits, and I wonder if they still have customers that only have 50% coverage, I did not ask that question. What a loss that would be to basically do charity work and take a loss on a claim, only so that Hanger would benefit and make the money. Nice business strategy, they can put us all out of business eventually if we take a loss on every service we provide.

I then asked if ABC Accreditation is required, and she said it was NOT required at this point, and that any person wanting to join the network would not be required to have accreditation or certification. I again had a "wow" response to this, and asked her if they were THAT desperate that they would just allow ANYONE to join in, and how in the world could they ever just let anyone join in with NO certification or accreditation. I thought that was one of their big advertising and seeling point, that they would have only the highest quality standards and requirements by going to this network. (On a side note, Point Source is still in the Cigna network at the request of Cigna, and they DO require ABC Facility accreditation, and also cerfitication, and their reimbursement rates are a LOT higher than what Linkia is offering....I am NOT affiliated with Point, I am not on their payroll or have anything to gain by saying this).

So, what is going on here? Maybe it is due to some legal activities going on that they are scrambling to get people other than HANGER facilities in the network.

If anyone knows of the legal actions that are going on here, please advise us and fill us in on what is going on. I have gotten some information about the legal battles that Hanger is involved with over stock trading, the medicare issues in New York, and the OIG being on them, etc. But I don't have any credible information about what is going on with Cigna and Linkia. Something must be going on for them to be offering this enrollment with no credentials or anything.

We all need to really think about what impact this will have on the field if we join this network, or any other network similar to this one. Are we going to help them build a network that can eventually end up eliminating the competition, which has been a huge discussion lately. I cannot make any comment on what anyone in this field should do, only pose the question and let everyone out there think about it on their own and make their own choice. I know what my answer to this is.

I know what Cigna has paid in the past, and I also know what Cigna pays if you are through another network, like Point, which all I can say is they pay a LOT more than what Linkia is offering. I went back over a few of the claims that I have filed with Cigna, and saw what they paid during the past 2 years. Now, through Linkia, the prices have dropped about 40%. How is this good for anyone out here, especially the amputees??!!

From what I can gather from all this is, Cigna must still be allowing the same amounts, but they give the money to Linkia first, and then Linkia keeps whatever they can get away with, or what we will tolerate. They keep the rest. That is the ONLY way Linkia can make any money.

We need to all look towards the next Hanger quarterly meeting, which is in a few more days. We need to see how much Linkia has made in this last quarter, and see what they project the dollars to be in the upcoming quarter. Just remember, Linkia does not fabricate anything, they do NOT produce anything, they do NOT see patients, the do NOT DO ANYTHING to make any money. The ONLY way they can make money is by skimming money off each claim that gets processed. They only make money by stealing a portion of the payment that Cigna has paid for a device or service, and that is money that should be paid to the actual provider, and NOT SOMEONE THAT DOES NO
WORK or provide any services.

We need to talk about this with everyone in every area of the country. We CANNOT make any plans of boycotting anything, or cannot do anything like that at all. But, we can talk to each other, educate each other, even if the other facilities in your areas and not your friends, you need to talk to them, because they are probably not on this list serve and may not even have clue as to what is going on here.

Heaven forbid if we would expect any organization (ABC, AOPA, the Academy, etc) to educate us on this matter, after all, they are all filled with people from Hanger that run these programs. And, even the ACA, after their big InMotion magazine publication a month or so ago which harped for several pages about these evil insurance companies, and what we were all fighting against (speaking as an amputee), they still will NOT SAY ANYTHING to warn people about any group like Linkia, and just keep a very low profile on this issue. Why? I don't know, maybe they need the money from Hanger so badly that they will just ignore this problem.

On another topic that I mentioned in my last post, about SPS. I got many emails, lots and lots or emails, supporting what I was saying, and several from Hanger employees themselves. They have asked me to keep the remarks and identities private,
which I have always honored.

One of these emails explained that there is a lot of information and data that is collected by SPS, which only makes sense after I started thinking about it. SPS/Hanger can learn and collect information on geographic areas, where there are high volumes of sales. If there are lots of sales in some area, that must mean there must be a lot of amputees, and therefore, a great place for Hanger to go and open up an office. Another person sent me an email about how they had bought everything from SPS for years, not thinking about who owns it, etc. Then, all of the sudden, there was a Hanger office just around the corner from them, and they went out to conquer the area, giving great little gadgets and gifts to all the doctors offices, and tried to get the referrals. It worked for a while, and then the patients and doctors realized that the prosthetic devices were made using the cheaper components, and the patients lost that personal element with the practitioners.

So, if you are wanting to give all your data about how many patients you are working with, and give the competition all your information about your business, then just go right ahead and buy everything from a vendor that is owned by the company that wants to be in total control of the market. That is certainly not something that I would want to do with my office and business, give any information away that might entice them to come and open up next door.

Again, everyone needs to call the other facilities in the areas, discuss the future of O&P, educate each other on the issues: parity, licensure, medicare changes, managed care contracts, vendors, etc. Do not discuss anything that would be illegal, like price fixing, boycotting, etc.

We can leave all the price fixing discussion to the insurance companies, and to 3rd party administration groups, because for some reason it is legal for them to do, but not us, or at least that is what it seems.

Good luck out there.

Jim DeWees, CP

(Posted on O&P List Serve)

posted by Daniel Gottry at 1:52 AM