Private Insurer Relations

UnitedHealthcare Revises Coverage Policy for Magnetoencephalography (MEG) to include Positive Coverage Decisions

Neurologists that perform Magnetoencephalography (MEG) will be pleased to learn that UnitedHealthcare (UHC) has updated its coverage policy for the procedure. Specifically, UHC shares a positive coverage decision for MEG for pre-surgical evaluation in patients with intractable focal epilepsy and for pre-surgical evaluation of brain tumors and vascular malformations.

UHC joins Aetna and WellPoint as the third large private insurer to recently modify its coverage policy for MEG. (Click here to view the related Aetna story; Click here to view the WellPoint MEG Medical Policy.)

UHC references the AAN's own Model Medical Policy for MEG in its updated coverage policy. Subject matter experts within the Academy have provided valuable input on policies for UHC and other private insurers for the past several years to assist in updating medical coverage policies. UHC now provides the AAN with monthly updates on changes made to relevant medical policies.

Access UHC's updated MEG policy, effective as of August 13, 2010.

Learn more about the AAN's MEG policy.

Aetna, CVS Enter Pharmacy Agreement Starting January 1, 2011

CVS Caremark will administer Aetna's pharmacy benefits management services starting January 1, 2011. The 12-year strategic agreement is expected to enhance clinical capabilities, improve pricing and products and advance customer service and member experience.

Aetna will continue working with physicians and their patients to provide medical benefits and services. Physicians should continue to work with Aetna as they have previously, specifically:

This arrangement will not affect those medications or vaccines that physicians administer in their office and bill as a medical benefit, along with their services.

This will not affect Aetna members' benefits plans or co-pay requirements.

Refer to the Aetna Preferred Drug List (formulary) at http://www.aetna.com/formulary.

Physicians should continue to adhere to Aetna's precertification, step-therapy and other utilization management programs.

For questions about member benefits, step-therapy edits and precertification for medications, physicians should continue to refer to Aetna websites and call the telephone numbers listed on the member's ID card.

The AAN will continue working with Aetna to build a positive relationship that focuses on high quality patient-centered health care solutions.

Click here to view the Aetna news release.

UHC Offers Training on 2010 Premium® Physician Designation Program

UnitedHealth Care is offering live webinar training sessions to help practice administrators, office staff and physicians understand the new Web-based program tools and updated methodology associated with the 2010 UnitedHealth Premium® physician designation program.

The training sessions will cover new reports addressing quality and cost efficiency, new email and online features to the program, and delegation of authority, where physicians will be given the opportunity to share their information amongst others in their practice.

Click here for registration instructions and more information on this program. The program is scheduled to be released this summer.

Settlement Notice and documents for UnitedHealth Group UCR settlement mailed

On April 16, 2010, the Settlement Claims Administrator began mailing the Settlement Notice, claim form and claim form instructions for the UnitedHealth Group UCR settlement to physicians. Physicians will be receiving a plain white mailer with "United Healthcare" written on the bottom and with the return address referencing the Settlement Claims Administrator: United HealthCare Class Action Litigation c/o Berdon Claims Administration LLC, P.O. Box 15000, Jericho, NY 11853-1001. The mailer includes the Settlement Notice, claim form and claim form instructions. More than $350 million is available to compensate physicians and their patients for 15 years of artificially low payments for out-of-network services.

The following key dates are currently included in the settlement that physicians must follow

July 27- Deadline for filing objections to the settlement or for opting out of the settlement.
September 13- Date for the final settlement hearing to consider any filed objections.
October 5- Deadline for filing a claim to share in the settlement fund.

In an effort to help physicians file claims in the record-breaking settlement with UHG, the AAN is encouraging members to consult the following American Medical Association (AMA) resources:

Click here to find out if you are eligible to receive. (Go to number 6 on the FAQ).
Click here to view the AMA step-by-step guide to maximizing your recovery from the UnitedHealth Group UCR Settlement.
Click here to access an AMA FAQ page about the settlement.

AMA Practice Tip: Preparing for Health Insurer Retrospective Audits

The American Medical Association (AMA), with cooperation from the American Academy of Neurology, created the educational resource "How to prepare for a health insurer retrospective audit" to educate physicians and their practice staff about the recoupment efforts of health insurers through the retrospective audit process. Physician practices can use this resource to guide them through the retrospective audit process from the initial notification from the health insurer to contesting the audit's findings.

Visit the AMA Practice Management Center website to access the educational resource "How to prepare for a health insurer retrospective audit." AMA members can download this informative educational resource as a member benefit.

As a physician, you know there is strength in numbers. The AMA helps all physicians, regardless of specialty or practice setting, speak with a unified voice on the most important issues facing medicine. Please encourage the physicians in your practice to join or renew their AMA membership online, by calling (800) 262-8335.

AMA Practice Tips Related to Payer Advocacy

Physician profiling: How to Prepare Your Practice
Negotiating Contracts (February 17, 2009)
Losing revenue through inappropriate health insurer adjustments (March 10, 2009)
Resources for Physician Profiling (June 2009)

Payment Policy Subcommittee Recommends Resource for Payer Negotiations

Members of the Payment Policy Subcommittee reviewed and now recommend The Physician's Comprehensive Guide to Negotiating with Payers as an additional resource to assist Academy members in their payer negotiations and contracting. Written specifically for physicians, the book gives detailed examples of achieving success through the application of essential negotiating skills.

Purchase the book and view many other resources at the AAN Store.