During a recent Town Hall meeting of the Dade County Medical Association (DCMA), physician frustration with continued reimbursement challenges from insurance carriers boiled over into a lively and highly productive conversation. The focus on the discussions related to the Medicaid Managed Care Program and the Enhanced Payment Program which when fully implemented will guarantee Medicare level reimbursement for all in-network physicians providing services to pediatric Medicaid Beneficiaries. The discussion also included commercial carriers and the continued use of prior authorization and peer review procedures that cost physicians an incredible amount of time and resources in trying to secure coverage for medically necessary care on behalf of patients.

It is clear that the consolidation within the health insurance industry and a lack of regulatory oversight in Tallahassee continues to embolden insurance carriers’ efforts to increase administrative burdens and reimbursement denials on physician practices.
 
In response to these ongoing challenges, the DCMA Executive Committee has approved the launch of an initiative to provide recourse for DCMA physician members to reach out for assistance if they experience inappropriate denials and other administrative hassles from insurance carriers. Once the reporting mechanism is launched on our website, DCMA staff will collect these reports and work with our regulatory contacts in Tallahassee to address individual concerns. If necessary, our staff will refer members to local legal professionals who have volunteered to assist in this program to defend our physician’s interests.
 
The DCMA exists to represent the interests of our physician members. The leadership strongly believes there is no single issue more important for us to engage in than the defense of our members who are wrongly denied reimbursement through errors or unfair business practices of insurance companies.