Longtime Member Expresses Gratitude for Services Provided by MSSNY
Dear MSSNY:
Most recently I was the recipient of a “take back” from an insurance provider. This related to over 70 patients throughout a two-year period of time for whom I had received payments based upon an incorrectly processed fee schedule at a higher rate than should have been, according to the carrier. My office had tried to notify the carrier at the time of each claim’s processing of each EOB, and each time we were told they had no way to correct this issue but will notify us at need. To my surprise I was asked to pay back over $24,000.00 in bulk as a single payment, or payments would be subtracted from future processed claims until that dollar amount would be met.
In calling the carrier we were given the individual claims which had been “adjusted” to reflect a correct list of those patients, and other than that there was no help from their office.
As a MSSNY member for decades I have always approached our leadership therein for guidance when needed, and their assistance has been invaluable. This, however, was the first time it entailed monetary help from a wrongly processed fee schedule from a commercial Insurer.
Upon calling the MSSNY I was directed to the Physician Payment office. Enter Ms. Heather Lopez. Ms. Lopez is the Vice President of Physician Payment and Practice. She asked I do nothing until she had a look at a copy of the recouped claims. While these were emailed to her within a half hour, she actually called me back a few hours later and told me she had already been on the phone with the carrier. In reviewing the laws in New York State, she had the carrier immediately drop over a dozen of the claims due to their having run afoul of the two-year time frame limit for such claims reprocessing. Thereafter she spent no less than three or four hours either on the phone with the insurance providers staff or in front of the computer, writing to me no less than 20 times over two months, and providing me with at least a dozen phone calls, until she had managed to get the final claims reprocessing down to about $2300. Amazing. I actually did nothing other than watch her at her best.
There is no other resource I could have used who understood the claims processing, related New York laws, and who had the contacts with the carrier, to help me with this issue. Ms. Lopez was always professional, educating, and timely. This V.P is truly a wonderful resource for all of us who are members of MSSNY.
I could have named multiple people from within the Society over my 30 years + membership who have been an asset to me for a variety of issues, but Ms. Lopez was only the most recent. At one point I had to find a labor lawyer for a staff member who was repeated verbally abusive to other staff. At another time I had protesters outside my office who were convinced that I was performing abortions, and the MSSNY helped me with that problem. And most recently I needed counseling about a Covid related issue when staff members in my private office were not in agreement about mask usage. There have been another ten times I could remember wherein the Society was always available for practice or professional needs.
If anyone has a question as to whether membership is “worth it” in the MSSNY my answer is “of course”. Due to Ms. Lopez’s efforts I have been saved a great deal of headache and time and effort from my large “claims recoupment”. We will all have such business-related needs over time even if we’re the best doctor in the world. The Society is the only place I could have turned to for these varied needs.
Thank you, Ms. Lopez, and thank you MSSNY, for having provided me with your service these many years.
Respectfully,
Laurence F. Mack, M.D., FACOG
