Colorado Medical Society

Introduced by:           Thomas J. Allen, MD

Subject:                      Insurance Plan Reimbursement

Referred to:               Reference Committee on Health Affairs

 

WHEREAS, United Healthcare and potentially other health insurance plans have recently taken the position that they will not reimburse the professional component of radiologic services to physicians providing an office service and radiologic procedure concurrently, claiming that the professional service is part of the office visit, and

 

WHEREAS, United Healthcare and potentially other health insurance plans have recently taken the position that a certain percentage of physician visits to their insureds be of the lower level of service regardless of the indicated need and/or severity of the patientŐs condition, and       

 

WHEREAS, United Healthcare and potentially other health insurance plans have recently taken the position that they will not reimburse office visits for necessary medical care of identified medical conditions when provided at the same time and day of service as a preventive health service, regardless of the fact that such medical care may add significant additional identifiable elements of service as specified in CPT codes for such services, therefore be it        

 

RESOLVED, that the Colorado Medical Society shall take all necessary steps to see that physicians providing radiologic services to their patients will be reimbursed by health insurance companies for both the technical and professional components of the radiographic procedures provided unless such physicians have delegated either of these components to another physician or entity which will charge separately for the service, and be it further

 

RESOLVED, that the Colorado Medical Society shall take all necessary steps to see that physicians providing care to patients for both preventive needs and needs relating to a medical condition diagnosis shall be reimbursed for all such medically necessary or indicated services whether provided on the same or separate dates and times of service, and be it further

 

Text Box: FISCAL IMPACT: None RESOLVED, that the Colorado Medical Society shall take all necessary steps to see that physicians are reimbursed by health plans for any levels of service which are documented in the medical record as to their provision and medical necessity.