Dan Gottry - Blog

Dan Gottry's Blog

Wednesday, November 29, 2006

CIGNA Slow on Responsiveness

The following was sent to CIGNA, November 29, 2006, following a significant period with no response to questions about the qualifications of Hanger Facilities:

Christine . I have included below the questions that I sent to you on October 26th. November 2nd, and November 10th, regarding some of my concerns with the provision of services by Hanger facilities under their new, very limiting, contracts with CIGNA. I know that you have passed them on but, to date, I have had no response. I have highlighted my specific concerns in the copies below.

I understand how you ended up in the middle of this because of the questions I raised about the legal issue surrounding this issue. However, I also know that this issue does not fall within your area of responsibility.

Can you please provide the name and email address of the person who has ultimate responsibility for decisions related to contracts for O/P services?

It is my opinion that CIGNA has, unknowingly, become a victim (as have your patients) in this situation. I continue to hear more horror stories of inappropriate care being provided by unqualified practitioners.

I have a strong interest in helping CIGNA to determine a better, mutually beneficial, solution for the provision of consistent, qualified care for amputees and others who require these services. I firmly believe that CIGNA has made a strategic error in the direction they have chosen and inevitably needs to rethink those decisions. You will recall that I have suggested that there would be benefits to CIGNA to involve some of the users of these services in the decision process and have offered to help in any way possible. That offer still stands!

Once I have a contact name and email I will communicate directly with that individual!

Thanks

Dan

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Daniel Gottry
dan@gottrys.com
Visit: www.gottrys.com

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-----Original Message-----
From: Daniel Gottry [mailto:dan@gottrys.com]
Sent: Friday, November 10, 2006
To: Reuther, Christine A ESQ TL16F
Cc: Doherty, Jeannine 397
Subject: Provider qualifications

Thanks, Christine. I am still waiting for a response on this. I would guess that some of these answers are hard to come by.

I was rereading a response from CIGNA in which local staff said that Linkia was imposing the same standards (accreditation) on its Hanger facilities as it was on outside providers with which it may contract. The accuracy of that statement seems to be more in more in question as I find more Hanger sites without accredited clinicians and no facility accreditation.

After reading an article in The O&P Edge, I had another question. Hanger's CEO indicated that it does not require exclusivity in its agreements with insurance companies. That seems to be contrary to some information that I've received from CIGNA. Is there any level of exclusivity required in your contract with Linkia??

I have also requested info in why McCleve O&P is still under contract with CIGNA in this area while others have had their contracts terminated. While CIGNA has said told me the longevity of this contract is unknown, word in the rumor mill is that McCleve's contract is still in place because of a longstanding relationship between one of the McCleve brothers and an individual higher up the food chain at CIGNA.

This seems a bit bizarre but, perhaps you could shed some light on why a provider such as McCleve still remains under contract, contrary to CIGNA's stated direction in O&P services!

Thanks! I look forward to hearing from you!

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Daniel Gottry
dan@gottrys.com
480-491-1020
Visit: www.gottrys.com

-----Original Message-----
From: Daniel Gottry [mailto:dan@gottrys.com]
Sent: Thursday, November 02, 2006
To: Reuther, Christine A ESQ TL16F
Cc: Doherty, Jeannine 397
Subject: Provider qualifications

Christine ... haven't yet heard anything about the non-qualified provider in the neighborhood of my office ... but, I thought you might be interested in this letter that I received regarding Linkia's double standard ... resulting in CIGNA patients being cared for by non-qualified providers. I know there are many patients interested in knowing more about how this is really working out!

Thanks

Dan
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Re: Linkia/Double Standard

First I would like to commend you for the work and input you have and are doing regarding the Linkia / Hanger situation. I work for a very small Independent with 2 locations . One in Memphis, Tn. and I am in a small rural town 120 miles away. We approached Linkia at the beginning of this whole process and never heard a reply. At the second approach we were told being that Hanger has several location in Memphis we could not be in network with Linkia and also the location for which I am at would most likely not be in network either. The 2 closest Hanger facilities to my location is 75 miles away.

Now, I would like to hit on a subject that struck me a couple days ago that is completely being over looked at the present time, I believe.

THERE ARE DOUBLE STANDARDS GOING ON !!

According to the rules of Linkia, you have to have ABC Accreditation for Network Participation. (exact words) Not all Hanger offices are ABC Accredited!! The 2 closest Hanger offices to me are not ABC Accedited . One of these Hanger locations, in PaducahKy. have (3 )full time ABC Certified practitioners. Not sure why they are not yet accredited. The other Hanger location in Jackson,TN.has (NO) full time Certified practitioner.They can not be accredited with no ABC Certified practitioner.

So how is it that Linkia's rule of participation is not being enforced ???

How is that Linkia contracts with Cignia with rules and regulations that are to be gone by but yet are not being followed ?? Does Cignia know that Linkia is not up holding their own rule especially when it is Hanger offices?? It seems to me that any Hanger office that is not ABC Accredited when seeing or that has seen a Cignia patient thru Linkia would be in violation of Linkia's rule and Cigna should not be liable to pay the claim.

Oh well, guess another situation Hanger will get away with!!

By the way , even if we were able to participate with Linkia , we would not !! Not at the low reimbursement that is contracted ! (35% below medicare) Right!! We also are no longer going to be using SPS as a supplier, I am switching to Cascade Orthopedic Supply.

Again Thank You for your support for the Independent!

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Daniel Gottry
dan@gottrys.com
480-491-1020
Visit: www.gottrys.com

From : "Daniel Gottry"
Sent: Thursday, October 26, 2006
To: Reuther, Christine A ESQ TL16F
Subject: Provider qualifications

First, I want to say thanks for the 90 day extension for me to complete my process with my prosthetist. That is very helpful and appreciative ... and will hopefully allow me to survive until whatever changes occur that will allow me to continue to see a provider that I trust!

I did notice that there is now a Hanger office located in the medical building where my surgeon formerly officed, somewhat convenient to my office. The clinician name on the door is David Sharma.

I was surprised that, according to the American Board for Certification in Orthotics and Prosthetics website, David Sharma is not a certified clinician. The absence of his name in both the ABC book and the BOC book leads me to question whether David Sharma has either a license or certification to practice O&P.

This concerns me as I consider Linkia's promise to provide a "uniform level of quality and care".

There is a Susan Sharma listed on the ABC website as working with Hanger in Phoenix. Reportedly, this is David's sister.

One of my questions from the start was whether Hanger was abiding by the standards that Linkia is promoting. In this case I question whether they are being up front with CIGNA about the quality of their clinicians.

I'd appreciate your help in securing/providing any information that you can about David Sharma's qualifications and certifications.

Thanks!

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Daniel Gottry
dan@gottrys.com
480-491-1020
Visit: www.gottrys.com

posted by Daniel Gottry at 8:12 AM