In an effort to assist our members with insurance problems and inquiries, this portion of the ACR website contains various types of insurance information and resources. These resources include insurance letter templates, auditing resources, the ACR Health Plan Complaint Form and much more.
Resources:
- Health Plan Complaint Form—In an effort to better assist the membership in addressing both individual and system wide insurance issues, the ACR has developed a standardized complaints form.
- Letter Templates—Members can use the ACR templates letters to generate responses to insurance carriers.
- Medicare— information such as medicare fee schedules, information about medicare part D, and letter templates relating to medicare issues.
- Model Biologics Policy— The ACR's Model Biologics Policy can be used nationwide to reduce administrative burden among rheumatologists, patients and insurers, and allow physicians to properly treat patients without administrative delays. In an effort to make sure that the best care is provided to patients, the ACR has developed a standardized prior authorization form.
- The Recovery Audit Contractors—developed by the Centers for Medicare and Medicaid Services in an effort to ensure correct payments to providers and suppliers in the Medicare Fee-for-Service program.
If you have any further insurance questions or issues, please contact the at (404) 633-3777.
Insurance Subcommittee
The Insurance Subcommittee of CORC was created in 2009, and has been proactively functioning since with approximately 10 members recruited by the ACR staff as well as 2 ACR staff members. This subcommittee's purpose is to coordinate and engage in all activities that improve the practice environment of rheumatology as it is affected by health insurers; including: patient access to high quality care and treatment, reimbursement, regulation, and reviews of various drug and treatment policies.
If you have an insurance issue, please do not hesitate to ask for the Insurance Subcommittee for help! The Insurance Subcommittee cannot negotiate contracts for physicians, but are willing and able to investigate unfair practices from insurance companies that would put a patient at risk from their disease. Please fill out the Health Plan Complaints Form regarding your insurance issue, and the Insurance Subcommittee will do its part to assist you.
Insurance Subcommittee Members 2010-2011
Rudy Molina, MD- Chair
Alan Epstein, MD
Jennifer May, MD
Paul DeMarco, MD
Fredrica Smith, MD
Steven Spalding, MD
Seetha Monrad, MD
Penn Wickersham, MD
Nilsa Cruz, BS
Cindy Gutierrez - ACR Staff
If you have any further questions about the Insurance Subcommittee, or would like to join this subcommittee, please contact .
FAQs
Have an idea for a new insurance FAQ? Contact cgutierrez@rheumatology.org.
FAQs on Medicare
Click here to read frequently asked questions on Medicare.
Frequently Asked Questions
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+ Is there a place where I can find out what procedures and laboratory tests are covered by private insurers?
+ If an Insurance Company pays for services rendered by Doctors Office, yet does not post and cash check until after patient has moved on to a new plan, is patient still responsible for original payment?
+ How long does a company have to pay a medical claim?
+ Can you bill the patient for cancellations?
+ Do private health insurance companies cover and reimburse for self injectables ?
+ How do I know if my practice is collecting payment from insurance companies in a timely and successful manner?
+ Why do I get so many denials from insurance companies?
