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Thursday, August 31, 2006Impacting a Major IssueI hope you are realizing how these letters will impact this major issue in O&P and healthcare overall. GREAT JOB man. FYI, I forwarded you an email from ..... who is a major O&P advocate with a consulting firm. As she mentions she will continue your letter up the food chain as well. Name Withheld Linkia & ParityI was wondering when someone was going to realize that Linkia is not such a stellar concept; unfortunately it was a patient who had the realization of how exclusionary Linkia is. Patients will suffer by limiting who can provide O & P care. Daniel Gottry clearly explained from a patient point of view how his prosthetic care was compromised by Linkia and Cigna. Let's now think about Linkia as it relates to the issue of parity. Before I begin, let me simplistically rationalize what parity is. Parity is the idea that all insurance companies MUST provide O & P care. So is this in the best interest of the O & P profession? NO, because it would force insurance companies into one of two options. Option one would be to open a new division within their company to handle the O & P coverage. This would be very expensive for insurance companies and would defeat the purpose of cost effective money management. The second choice, and smarter one for the company, would be to contract with a third party payer such as Linkia to handle their new business of O & P coverage. Is parity such a good idea for the patient when it will exclude the majority of providers and limit the quality of care? I can only hope that the private O & P business owner realizes that they will not have the opportunity to get a piece of that pie because Hanger and Linkia will be consuming the whole pie, without equally sharing the taste of profit. To be the devil's advocate, parity is very beneficial for those patients whose insurance plans allow no O & P coverage. This will give them an opportunity to receive O & P care. But if Linkia is involved, Hanger will be obtaining the business and no one else. As an orthotist, I believe parity is not in the best interest of the O & P profession as a whole! I am hoping as practitioners, we can continue to educate ourselves on these issues so that before parity legislation passes, we can either support or fight against it. It now makes sense why Hanger is willing to support parity in each state. Dino Sharing the ConcernDan You did an AMAZING letter to Cigna! I know your prosthetist, and also saw it on the O/P listserv. THANK YOU for being so proactive. I am having our Prosthetics Department share your letter with their patients. Thank you. Your writing is well researched, organized and extremely impressive. Perhaps CNN should get a copy! Name Withheld Passing on the CommentaryDan, I just wanted to let you know that I appreciate your postings of your encounters along the way. You have taken on way more than anyone could expect or should endure in order to receive care. I will with your permission post this commentary so that my patients/clients can see the arguments you present so thoughtfully. Best Regards, Name Withheld Contact Local Attorney General's OfficeHow about contacting your local attorney generals office. Their job is to stop anti trust and anti competitive behaviour. Name Withheld Patients in Rural Areas SufferI want to commend you on your efforts to raise awareness with the Cigna/ Hanger/Linkia partnership and it's effectiveness to the O & P patients and facilities. The day we received the letter from Cigna , Linkia was called to make steps toward getting in network to be provider. I knew there would be no response and there was not !! I spent 12 years with Hanger and I know how they have evolved into nothing but ... I am confident in saying that most Hanger employees are totally dissatisfied with Hanger and its dealing and more and more are leaving Hanger because of it. The discount/fee Cigna is getting with the contact with Hanger/Linkia is 30% below medicare allowable . That's 30% below what medicare will pay. Even though Hanger has 600 facilities it cannot cover the whole country. I do O&P work in a rural area and the closest Hanger facility to my office is 75 miles. So patients in my area will have to travel 150 miles round trip each time they need to be seen . Some may not be able to travel and I know that the closest Hanger facility will not be traveling to patients homes to do the work. Another problem I see with this partnership is what happens if a patient is in the Hospital here in my town with Cigna Ins. and doctors orders a device for the patient. Is the closest Hanger facility going to travel that distance to take care of a Cigna patient. Usually a Hosp. patient requires at least 2 trips one to measure and one to fit a device. The patients especally in rural areas are the ones that are going to suffer due to this partnership along with us that are trying to provide the service the patient needs. Name Withheld Triumph of Hope Over ExperienceMr. Gottry, You are welcome to post your exchanges with Linkia/Hanger/ACA to AMP-L at the University of Washington, a listserv I moderate for amputees. Many of us are aware of Linkia, and expecting ACA to do anything for you is, uhhhhh, well, the triumph of hope over experience. Cheers Name Withheld Linkia Seeking ProvidersSaw your post on the list-server. Just a quick note on my experience with Linkia. I had Linkia, Inc. call me to get me to participate as a provider, as there are no Hanger facilities in my state, and they are striving to create their network out here. His proposal was that if I were to become a member of the network, that I would take 30-35% below the medicare allowable for my services. Our Medicare is near the floor already. I believe they are asking other providers for up to a 50% deduction, but am not sure. I can't tell you how long I literally laughed in his face, but that there will almost certainly not be anyone worth seeing that will accept this type of arrangement, and definitely no one in this area (which means patients will need to drive at least 2-4 hours out of their way to see a participating provider). Your are correct. The loser is the patient who has Cigna as their insurance. Hopefully Cigna will wake-up before they lose all their customers. Linkia is also trying to get these "exclusive" contracts for other insurance companies. Call and give them a piece of your mind @ 1-877-754-6542 ext. 3635. Name Withheld FTC on Selective ContractsDan, I found this and thought you might be interested. If you choose to repost this on the listserve or elsewhere, please keep my name unattached as there would be significant political repurcussions for me. The link is from the American Academy of Orthopaedic Surgeons who copied the text from the Federal Trade Commission. The selected passage below may be of interest. Sorry for the cryptic nature of this note. Good luck in your quest. Name Withheld http://www.aaos.org/wordhtml/papers/articles/antifact.htm. Section 9, paragraph 8 fromthe above link says: Selective contracting-Exclusion of particular providers may be a method by which networks limit provider plans in an effort to achieve quality and cost-containment goals, and thus enhance their ability to compete against other networks. Selective contracting may also be procompetitive by giving non-participant providers an incentive to form competing networks. A "rule of reason" analysis will again be applied. In examining exclusive arrangements, the Agencies will examine the degree to which the arrangements may limit the ability of other networks or health plans to compete in the market. The focus of the analysis is not on whether a particular provider has been harmed by the exclusion or referral policies, but rather whether the conduct reduces competition among providers in the market and thereby harms consumers. A Sly DealMr. Gottry, I am not sure what your profession is but those letters to Cigna are amazing. Great job!!! I used to work for Hanger and when the opportunity presented itself to leave, I did. I currently work for an independant company in ...... I find it curious that just within the last couple of weeks CIGNA gave us approval to be providers back dated to November 1, 2005. I am of course greatly concerned that they will see the error of their ways by us not being Linkia and resend that approval so I am not saying anything to loudly at this point. Personally, I felt when Hanger announced the contract with CIGNA that is was a sly deal. Linkia does have other contracts, CIGNA, United Healthcare, TriWest and MSC (work comp), however CIGNA is the only one that has said that Hanger is exclusive. I encourage you to keep being an awesome, well spoken advocate for the care for all amputees. We as a small business will do our part for continuing exceptional care for our patients both orthoticly and prostheticly. Name Withheld Everyone Involved Must ContinueI would like to thank Mr. Dan Gottry for his time and valuable comments regarding the impact of Linkia from a patient's point of view. I hope all of the owners and clinicians have read his Open Letter to Cigna and the responses from the Cigna administration. Everyone involved in O&P must respond to this issue and pass this information to your patients who will be impacted by these networks. Ask them to continue the efforts to contact Cigna on the national level. Patients are our strongest advocates. ACA and HangerHi Dan, It is highly unlikely ACA will make any statement critical of Hanger/Linkia. Hanger is probably their largest single advertiser. Their stance is similar to AOPA's. It is all about $$$$$! Good luck w/ your fight! Name Withheld Encourage Providers to Encourage ACA ActionIt is obvious from the large number of email responses that I have received to a posting yesterday that there is a great deal of concern about the contracts Linkia/Hangar is establishing with large insurance companies and the impact this has on the competitive market. I am a bit surprised and concerned that the ACA has, to the best of my knowledge, not yet stepped up to represent amputees on this issue. There may be a significant concern on their part to cross one of their advertisers ... but to appropriately represent their constituency, it is time for them to do so. It's important for amputees to be leading the charge with their insurance companies and with their senators/congressmen and state attorney generals. At the same time, it is equally important that O/P providers to talk to their suppliers (who support ACA through their advertising budgets) about encouraging the ACA to play a part in dealing with this critical issue. Take a few minutes today to call or write to your providers! Their words of encouragement to ACA will make a difference. Daniel Gottry Ge Tough!Dan, You as a policy holder will do more good than all of the independent PO firms together. Be tough! Name Withheld Wednesday, August 30, 2006Fight as a GroupWell done Dan. You are thoughtful and justly concerned. Any way we can get together as a group and fight this. Cigna is not the only national contract that Hangar controls. Name Withheld One Flake to Get a Snow Ball RollingDan, As a practitioner and a class mate of [your prosthetist], I submit to you. Why don't all the amputee's and practitioners get together and file a civil law suit against Hanger and Linkia? It takes just on flake ( no pun intended) to get the snow ball rolling. I personally think the ACA would be the best group to start the case. Name Withheld Top 10 ReasonsDan Rec'd your e-mail thru the list serve. Had to read your letters and lists, especially the 10 reasons why one leg is better then two. Understand, I am not an amputee, but I deal with them every day in my practice and I just have to congratulate you on overcoming your amputation and doing it with a sense of humor. You are truly uplifting to us all and you are a breath of fresh air. Thanks so much, Josh Ryder CIGNA/Linkia From a ProviderTHANK YOU! Because you are a patient and have presented the issues completely, without looking for personal benefit other than your own quality of service (and who could deny you that right?) I think it will be more effective than the same info presented from someone ... who is trying to get CIGNA to give independents another route to service their members that doesn't involve strengthening their competition! This would allow the efficiencies of contracting and credentialing that CIGNA needs to manage cost. I agree with you CIGNA and Hanger are forming a monopoly and if this trended to all large payers, would have horrible implications. I sent your post to both my CIGNA contacts and also to the FTC. Two legal opinions I have received assure me that nothing will happen with the FTC, but if not, why not? At any rate, I felt the need to try and believe your position and opinion has more potential to bring success then mine (another corporation trying to make money). Your research and conclusions are quite similar to a article sent to O&P Edge, who is planning to do a story on Hanger and the issues surrounding. Best of Luck from O/P InstructorDaniel, Best of luck in your efforts. They are appreciated. I teach in the Orthotic and Prosthetic Department (primarily Orthotics) at Century College. Let me know if I can every be of any assistance. Katie Voss, C.O. Hanger Competitor CommentsDear Dan, As a staff member for a network of independents that also competes with Hanger, I truly understand the effort that DID go into researching that open letter. It needed to be said, and you've done an excellent job!! I'm still reading and re-reading and want to commend you on your completeness and am thankful you have posted this. I'll be forwarding it to many others with similar interest. Regards, Susi Ebersbach Director of Business Development POINT Health Centers of America, Inc. |
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