I requested Anthem review my reimbursements on several in house procedures which I do because they are paying much less than the other insurance companies and even less than Medicare. Here was their reply:


> Dear Dr. Strouse,
>
> You can certainly submit a request for an increase in the current fee schedule. Once received, it will be reviewed and presented to the Reimbursement Committee for consideration. To assist with the analysis of your request for a fee review, a proposal should include the following:
>
>
>
> * Practice demographics (locations, number of practitioners and license held, years in practice, certifications/accreditations)
> * Please provide names/locations of facilities supported.
> * What percent of patient base is Anthem?
> * What counties do you draw patients from?
> * Since Anthem reimburses from a statewide fee schedule, please include justification as to why practice should be considered for an increase (i.e., what services provided by the practice are unique and not generally provided by other practices of the same type)."
> * In-office labs are reimbursed according to Anthem's Reference Lab Fee Schedule and will not be considered for an increase.
> * J-codes are reimbursed at ASP + 6% and will not be considered for an increase.
> * E&M codes are not negotiable.
>
>
>
> Anthem will not accept proposals submitted as an across the board or as a percentage of Medicare. Please email the proposal, attaching an excel table with requested CPT codes, and proposed fees for consideration

And my reply:

Thank you for your reply but I have a number of questions before proceeding. How can Anthem discriminate and pay one provider one fee and another something else as I know very well you are doing. It is against the law for me to do that. How does whether or not I provide unique services matter? If I provide a service, it should be reimbursed at the same rate as others providing the same service which I know you are not doing. Otherwise, one might construe this as being collusion on Anthem's part as regards to knowing and discussing what other providers are charging and accepting. It is against the law for me to do that. I believe before I send you any additional information, I will consult an attorney on these issues. In the meantime, I will stop performing these services on Anthem patients and instead refer them to the more costly providers.


Leslie
Hospital Employed Physician Who Misses The Old AC

"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "