01/10/2014    Matthew Garoufalis, DPM

Have you recently been dropped from an insurance network? (Billie Bondar, DPM)

APMA recognizes Dr. Bondar’s frustration at being
terminated from the Multiplan network; however,
APMA takes umbrage with Dr. Bondar’s comments that
the association has not been educating its
members. In fact, APMA has been diligent in
sharing information with members about provider
terminations, narrowing of provider networks, and
managed care contracting through its various
communication vehicles, including APMA News,
APMA.org, APMA Weekly Focus, and APMA News Brief.

APMA contacted Multiplan in support of Dr. Bondar
when she first reported the issue in November and
requested a meeting with the company’s medical
director to discuss a variety of issues with
Multiplan. Recently, in response to the Affordable
Care Act and other legislative and regulatory
actions, private insurance companies, including
commercial and Medicare Advantage plans, are
narrowing their provider networks and terminating
physicians, including podiatrists, from their
plans. Because the vast majority of members’
concerns have been focused on Medicare Advantage
Organizations’ termination of provider contracts,
APMA has created a wealth of resources on that
topic.

We encourage members to review the following
information on this subject:

June 28, 2012
APMA News Brief
Physicians Need New Approach to Managed Care
Contracts

July/August 2013
APMA Website
Medicare Advantage Termination FAQs

Sample Patient Letter and Communicating with
Patients About Termination from a Medicare
Advantage Plan

August 19, 2013
Weekly Focus
New Medicare Advantage Educational Materials
Available Online

October 2013
APMA News
Termination of Medicare Advantage Organization
Provider Contracts

November 8, 2013
CAC/PIAC 2013 Presentation
Emerging Issues in Private Insurance
Video on Health-care Reform (Preview)
Video on Market Trend
Video on Medicare Advantage (Preview)

November 27, 2013
APMA News Brief
‘Narrow Networks’ Trigger Push-Back From State
Officials

December 18, 2013
APMA Letter to CMS on Medicare Advantage
Termination

In addition to the information detailed above,
APMA and state Carrier Advisory Committee (CAC)
representatives and Private Insurance Advisory
Committee (PIAC) representatives keep each other
abreast of payers’ actions to narrow their
networks so we may effectively assist members.
Members are always encouraged to contact CAC/PIAC
representatives. To find your representative visit
www.apma.org/CACPIAC. Moreover, APMA continues to
advocate for APMA members and their patients. Most
recently, APMA has written to CMS and Multiplan,
and several weeks ago, APMA spoke with
representatives from UnitedHealthcare.

APMA continues its education effort through its
Reimbursement Webinar Series. The first webinar of
this year, “Affordable Care Act (ACA) in Action,
Sustainable Growth Rate (SGR) Repeal, and
Physician Payment Outlook for 2014,” will be held
on Thursday, January 16, from 8–9 p.m. EST. APMA
members may sign up for this complimentary Webinar
at www.apma.org/webinars. Also, the Private
Insurance Resource Guide at www.apma.org/PIRG
provides a wealth of materials to help members
with their contracting issues. Finally, APMA
members are welcome to contact APMA with questions
or comments at healthpolicy.hpp@apma.org.

Matthew Garoufalis, DPM, President, APMA,
mggaroufalis@apma.org

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