that much time invested in it and you see all the effort that the staff has put into this effort, as well as all the stake- holders — hospitals, doctors, consumers, health plans, carriers — then you want to make sure that one, the process is fair, but, two, the outcome at the end works like it’s supposed to.” Dr. Hinchey says in the end it prob-
Benevolent Fund assists Texas physicians and their families.
ably was a good thing the process took so long “because I think we got a lot of right answers.”
The Physicians
You’re not alone.
You work to keep yourself healthy and hearty, but sometimes a disabling illness arrives without warning. For more than 40 years, The Physicians Benevolent Fund (PBF) has been helping physi- cians and their families. Some have become infirm, others have had an accident, some have outlived their financial resources. Widows, children, and doctors themselves benefit from the fund.
PBF helps recipients with: • Rent or mortgage, • Utility bills, • Medical expenses, • Clothing, food, and more.
Call today for more information!
Where’s the problem? The debate over the adequacy of PPO networks and the financial implica- tions for patients has gone on for years. Health plans argued they frequently have difficulty reaching contract agree- ments, particularly with facility-based physicians, resulting in large numbers of patients getting balance billed for out-of- network care. But a January 2009 report from the
Health Network Adequacy Advisory Committee created under SB 1731 found that 90 percent of claims by facility- based physicians submitted to the five largest Texas PPOs were from in-network physicians, although the percentages varied substantially from plan to plan and by specialty. The report found that services sur-
We know it’s hard to ask for help, but you don’t have to go it alone. Contact TMA at (800) 880-1300, ext. 1602, or
chris.johnson@
texmed.org.
rounding emergency care were most frequently provided by out-of-network physicians. Anesthesiology and radiol- ogy followed. The health plans sought to reduce the incidence of out-of-network care by re- quiring facility-based physicians to con- tract with the same PPOs as their hos- pitals to retain staff privileges. Such a requirement was prohibited even before the new rules were drafted. Jared Wolfe, executive director of
Supported by the TMA Alliance 1/3 v
2.25 x 9.75
the Texas Association of Health Plans (TAHP), admits even he doesn’t think that is fair to physicians but “when they started putting certain requirements on the plans, our position was if you’re go- ing to require us to do these things, the only way we’re going to be able to com- ply is if we have some type of negotiat- ing leverage or a hammer with certain providers.” Mr. Wolfe says the plans contract
You’re not alone.
very seriously. Your investments should be there for your future. That’s why we won’t do anything with your money that we wouldn’t do with our own. We believe prudence is an asset other banks have overlooked. If you want your investments making money instead of headlines, think about who you’re investing with.
We know it’s hard to ask for help, but you don’t have to go it alone. Contact TMA at (800) 880-1300, ext. 1602, or
chris.johnson@
texmed.org.
frostbank.com/switch
Supported by the TMA Alliance 1/4 V (3 7/16 x 4 7/8)
The Physicians Benevolent Fund (PBF) has been assisting Texas physicians and their families for more than 40 years. Some have become infirm, others have had an accident, some have outlived their financial means. If you have depleted your resources, you may qualify for PBF assistance.
Call today for more information!
You’re not alone.
The Physicians Benevolent Fund assists Texas physicians and their families when infirmity or accidents deplete financial resources. We know it’s hard to ask for help, but you don’t have to go it alone. Contact TMA at (800) 880- 1300, ext. 1602, or
chris.johnson@
texmed.org for more information.
Supported by the TMA Alliance 1/6 H: 4 13/16 x 2 1/4 November 2011 TEXAS MEDICINE 33
You’re not alone. The Physicians Benevolent Fund assists Texas physicians and their families when infirmity or acci- dents deplete financial resources. We know it’s hard to ask for help, but you don’t have to go it alone. Contact TMA at (800) 880-1300, ext. 1602, or
chris.johnson@
texmed.org for more information.
Supported by the TMA Alliance 1/6 V: 2 1/4 x 4 13/16
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