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AAMRO ........................................................ 46 Alfredo L. Viteri MD, PA ...........................51 Athenahealth ................................................9 Avita Pharmacy ..........................................32 Baylor Healthcare.......................................19 Capital Farm Credit ..................................33 Covenant Medical Group .........................17 DSHS HIV/STD Program ......................... 10 Frost Bank ....................................................45 Humana .......................................................IBC Husch Blackwell ......................................... 10 James C. Neathery & Associates, Inc. .......................................54
Kindred ............................................................6 Leichter Law.................................................13 MacPractice .................................................52 Mayo Clinic.............................................14, 52 Med-Enterprises, LLC ...............................51 nVenio Analytics .........................................31 REC — North Texas ....................................41 Rose Walker LLC ........................................18 Shannon’s Hope Foundation ................45 Sharp & Cobos, P.C. Attorneys at Law .......................................................40
Tejas Ear, Nose and Throat, P.A. ...........15 Texas Health Steps............................... 5, 27 Texas Medical Association Academic Medicine Award ................28 Bank of America ....................................53 Foundation ...............................................36 Hard Hats for Little Heads .................47 Membership .............................................56 Practice Consulting ................................. 3 PSO .............................................................42 TexMed 2014 ........................................... 46 TEXPAC .....................................................28
Texas Medical Association Insurance Trust ...........................................................BC
Texas Medical Liability Trust ........35, IFC Texas Mutual Insurance Company ......34 Transfirst .......................................................53 West, Webb, Allbritton and Gentry, PC ................................................32
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44 TEXAS MEDICINE November 2013
ing health plans to require physician dis- closures when they have an “ownership interest” in an out-of-network referral “facility.” Having to disclose a broader “financial interest” in entities other than a facility, however, goes beyond what TDI allows, Mr. Spangler says. The form forces physicians to disclose a financial interest even if it’s not relevant, for fear of leaving something out and being penalized. TMA Payment Advocacy Director
Genevieve Davis adds the policy puts physicians in the position of having to educate patients about Cigna’s policies, when their primary focus should be giv- ing them the care they need. If patients believe their doctor is acting on behalf of the insurance company to deny care, rather than in their best interests, that could interfere with the patient-physi- cian relationship.
Cigna’s defense Cigna declined Texas Medicine’s request for an interview. In a written response, Cigna executives Mark Netoskie, MD, and Frederick Watson, DO, said the out- of-network form helps patients make in- formed decisions.
“Cigna contracts with health care pro- fessionals so that our customers can ob-
tain the primary and specialty care they need at an affordable cost. In most situ- ations, our customers expect to receive medical care from doctors and facili- ties that are in Cigna’s network, even if their doctor refers them elsewhere,” they wrote. “We also believe that individuals have a right to know if their doctor has a financial interest in the practice or facil- ity to which they’re being referred.” They said some out-of-network health
care professionals or facilities charge fees up to 1,000 percent higher than market rates or forgive patients’ respon- sibility for their share of out-of-network charges. The Cigna representatives ac- knowledged that most out-of-network professionals do not do such things, but said those who do hurt local employers and consumers when those costs are passed on in the form of higher premi- ums or reduced health care coverage. The form, on the other hand, helps
protect patients from what Drs. Netoskie and Watson described as “unwelcome surprises” from out-of-network billing. “If Cigna customers have out-of-net- work benefits, they’re free to choose out- of-network services in partnership with their physicians. However, we believe they have the right to understand the consequences of that choice and have all
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