Have You Been Wrongly Terminated from UHC Networks?
Friday, June 27, 2025
Have You Recently Received Denied Claims from UnitedHealthcare Due to “Non-Participating” Status?
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We Can Help!
The Physician Payment & Practice Division at MSSNY has recently seen an increase in cases where long-standing providers—some with over 20 years of participation—have been incorrectly terminated from UnitedHealthcare networks. These errors lead to claims being inappropriately denied under a “non-participating provider” status.
If this has happened to you or your practice, we’re here to help.
We will work with you to:
- Identify the root cause of the termination
- Assist in having denied claims reprocessed and paid
- Support efforts to ensure your practice is reinstated promptly if the termination was made in error
📧 Contact us at: [email protected].
Have You Been Adversely Impacted by MultiPlan’s Discounting Tactics? Please Let Us Know
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As has been widely reported, the American Medical Association and the Illinois State Medical Society have filed a lawsuit against MultiPlan alleging a price-fixing conspiracy with commercial health insurance companies, that resulted in below market reimbursement rates paid to physicians for providing care to patients on an out-of-network basis. The complaint, American Medical Association and Illinois State Medical Society v. MultiPlan Inc., was filed in the U.S. District Court Northern District of Illinois.
The AMA is currently working closely with state medical associations and national specialty societies to advance this lawsuit. To help with this effort, please let us know if you believe you have been personally adversely impacted by Multi-Plan’s discounting tactics, including specific claim examples by emailing [email protected].
What Physicians Need to Know about BCBS Settlement
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A $2.8 billion settlement has been reached in a multi-district litigation filed against Blue Cross Blue Shield Association (BCBSA) and its affiliates, resolving an over decade-long antitrust class action lawsuit. This settlement, one of the largest in healthcare antitrust history, addresses claims that BCBSA and its member plans violated antitrust laws by dividing the U.S. into exclusive service areas, limiting competition, and underpaying healthcare providers for reimbursements. Physicians may be eligible to claim a portion of this settlement and are encouraged to follow the guidance below.
The lawsuit, In re: Blue Cross Blue Shield Antitrust Litigation (MDL No. 2406), filed in 2012 in the U.S. District Court for the Northern District of Alabama, alleged that BCBSA and its affiliates engaged in anticompetitive practices. Hospitals, physicians, and other healthcare professionals claimed that the BCBSA’s BlueCard program and exclusive service area agreements suppressed competition, increased insurance costs, and reduced reimbursement rates. The settlement, announced on October 14, 2024, and granted preliminary approval on December 4, 2024, by Chief U.S. District Judge R. David Proctor, includes a $2.8 billion fund and significant operational changes to BCBSA’s operations.
Practitioners who are eligible to receive payments include physicians who provided healthcare services, equipment, or supplies to patients insured by a Blue Cross Blue Shield plan (commercial plans only, excluding Medicare, Medicaid, or Federal Employee Health Benefits Program plans) between July 24, 2008, and October 4, 2024. Certain other practitioners are excluded from the settlement class, including: (i) practitioners owned or employed by BCBS plans; (ii) practitioners who previously released claims against BCBS in earlier settlements, such as Love v. Blue Cross and Blue Shield Association); (iii) and practitioners who exclusively offer prescription drugs, durable medical equipment, medical devices, independent clinical lab services or standalone dental/vision insurance services.
Eligible physicians can file a claim to receive a portion of the $2.8 billion settlement fund. After attorney fees (up to $700 million), approximately 92% of the fund is allocated to hospitals and facilities, with 8% ($160 million) reserved for medical professionals, including physicians and medical groups/organizations. The respective payout amount depends on:
- Total charges billed to BCBS patients from 2008 to 2024 (higher billings yield more “points”, from 1 point for under $250,000 to 5 points for over $1 million);
- Geographic adjustment based on a “harm coefficient” reflecting BCBS’s impact in your area (multiplier from 1 to 5.3); and
- Number of claims filed by other practitioners, as funds are distributed proportionally.
Individual physicians and groups could recover significant sums, with some estimates suggesting millions for larger entities. By participating in the settlement, physicians should know that they release BCBSA from further antitrust claims related to the lawsuit’s allegations. However, claims unrelated to antitrust issues (e.g., contract disputes) are likely unaffected.
To ensure you benefit from this settlement, consider the following steps:
- File a Claim by July 29, 2025:
- Visit the official settlement website at www.bcbsprovidersettlement.com to submit a claim online (recommended) or by mail;
- Use the Professional Claim Form for individual physicians or medical groups, or the Facilities Claim Form for hospitals and facilities. Some organizations may need both to capture professional and facility fees;
No supporting documentation is required initially, but the Settlement Administrator may request it later. Provide your National Provider Identifier (NPI) or Tax Identification Number (TIN) for the administrator to calculate your “Allowed Amounts” or submit your own billing data.
–David Vozza, Esq., MSSNY Legal Counsel
Build a Sustainable Private Practice in New York with MSSNY by Your Side
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As more physicians reconsider hospital employment, many are returning to the independence and ownership of private practice. A recent Medical Economics article outlines three key elements for building a successful group practice: a strong operating agreement, a transparent income distribution model, and clearly defined buy-in and buy-out terms. Each of these is essential for fostering collaboration, preventing conflict, and ensuring long-term stability.
MSSNY is here to help New York physicians navigate these complexities with confidence. From legal guidance on crafting operating agreements to educational webinars on income models and partner transitions, MSSNY provides practical, physician-centered resources for every stage of private practice development. Our advocacy, financial tools, and expert consultations are designed to support your autonomy while protecting your long-term interests.
Whether you’re establishing your own practice or joining an existing one, MSSNY ensures you’re equipped with the knowledge, peer support, and policy insight to succeed. Join today and gain the support system you need to thrive in private practice.
Key Considerations for Physicians Joining or Forming a Group Practice (Doolin, McIntyre, Medical Economics, 6/20)
Addressing Brooklyn’s Health Crisis: A Call for Physician-Led Equity Solutions
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Despite SUNY Downstate’s historic role in educating physicians and caring for Brooklyn residents, the surrounding community faces deeply entrenched health disparities. Nearly 60% of Brooklynites live with at least one chronic illness—yet many lack consistent access to care. The newly released Downstate Community Advisory Body (DCAB) report outlines a comprehensive strategy to reshape Medicaid and public health delivery by centering community voices and structural equity.
The report calls for long-overdue investment in underserved areas, greater trust-building between health systems and patients, and policies that prioritize local needs, particularly in communities of color. For physicians, this represents an opportunity to lead from the front.
MSSNY’s Dr. Donald Moore (2nd from left) with Governor Kathy Hochul following the release of the Downstate Community Advisory Board’s finalized recommendation report
Bronx County Executive Honored Among NYC’s Top Healthcare Achievers
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Ronald Blount, Executive Director of the Bronx County Medical Society, was recently recognized by New York City Mayor Eric Adams as one of the “Healthcare Achievers of New York” for his outstanding grassroots, community, and legislative advocacy in healthcare. The prestigious award, presented during a reception at Gracie Mansion on June 9, 2025, was held in partnership with the Federation of Indian Physicians Associations and the Health Care Advisory Council.
Selected as one of only ten honorees citywide, Blount was celebrated for his deep commitment to uplifting underserved communities and amplifying the voice of organized medicine in the Bronx and beyond. His tireless efforts have helped shape local health policy, expand access to care, and foster physician engagement at the grassroots level.
MSSNY congratulates Mr. Blount on this well-deserved honor and celebrates the vital role county leadership plays in advancing the mission of organized medicine throughout New York State.
Urge Governor to Veto Legislation to Expand Surgical Scope of Podiatrists
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Physicians are urged to contact Governor Hochul to request that she veto S.6693-B/A.4613-B, legislation which passed at the very end of the Session that threatens patient safety by significantly expanding the scope of surgical practice for podiatrists without ensuring adequate training, oversight, or patient protections. MSSNY has joined with the New York State Society of Orthopedic Surgeons and several other specialty societies to oppose this legislation.
There are a number of serious concerns with this bill but the greatest concern is its authorization of podiatrists to perform partial and total ankle replacement (TAR), a high-risk procedure that is not required in core podiatric residency training. TAR is one of the most technically demanding procedures in surgery, with significantly higher complication and revision rates when performed by low-volume or inadequately trained surgeons. The complexity and risk of this procedure demands training and oversight consistent with orthopedic surgical pathways.
Other concerning provisions include:
- Extending operative authority for podiatrists to soft tissue of the leg below the tibial tuberosity .
- Expanding wound care privileges to areas above the ankle, using vague “contiguity” language without required with vascular or plastic surgery, even though such wounds often involve systemic disease and require multidisciplinary coordination
Urge Governor to Veto Latest Wrongful Death Bill and Preserve Patient Access to Healthcare
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Despite the fact that Governor Hochul has vetoed legislation three times that would greatly expand damages awardable in wrongful death actions and dramatically increase our already high liability insurance premiums, near-identical legislation (S4423/A6063) has once again passed the Senate and Assembly.
Thank you for your previous grassroots efforts urging a veto. However, with the bill again to be delivered for her consideration, it is imperative for physicians to again Urge the Governor to Veto the Latest Wrongful Death Bill and Preserve Patient Access to Healthcare and urge that any legislation to update New York’s wrongful death law be balanced to also bring down our extraordinary medical liability costs.
Please remind the Governor that this legislation is fundamentally at odds with the policy efforts of many who seek to protect and expand patient access to care. Moreover, it is even more untenable given the potentially drastic cuts to New York’s healthcare system that could arise from legislation out of Washington.
Physicians Across the Country Continue to Push Back Against Proposed Drastic Cuts to Medicaid and Failure to Address Medicare
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Following last week’s statement from MSSNY President Dr. David Jakubowicz, MD, telling Congress to Go Back to the Drawing Board to Ensure Patients Get the Care They Need, MSSNY this week joined in a letter to US Senate leaders from 47 state medical associations to urge the US Senate to reject the damaging cuts to Medicaid, Medicare, and medical student loan programs in the Senate Finance Committee draft budget reconciliation bill, noting that “these cuts will seriously harm access to health care for all Americans”
Physicians are urged to continue to send communications to their Congressional representatives Urge Congress to oppose steep cuts to Medicaid. As previously reported, the US House of Representatives recently passed by a single vote (215-214)their reconciliation budget package that would cut hundreds of billions in funding for Medicaid and the Affordable Care Act.
Unfortunately, the Senate doubled down on the potential damage to our healthcare system by deepening Medicaid cuts and failing to include any language to prevent future cuts to Medicare physician payment, which has been cut each year over the last several years.
It is estimated that these changes could cause 1.5 million New Yorkers to lose existing health insurance coverage. It also estimated that these changes, if enacted, could cause New York to lose $13.5 billion annually in federal funding Governor Hochul and House Democratic Leader Hakeem Jeffries Warn of Detrimental Impacts , which could cause steep cuts to various New York healthcare and insurance programs.
Furthermore, the proposed Medicaid changes raise grave concerns that they will jeopardize state funding for the payment of care delivery including required documentation of having worked 80 hours per month for people ages 18-64, with a start date of December 31, 2026, more frequent eligibility redeterminations for Medicaid eligibility, impose co-pays on Medicaid beneficiaries who earn more than 100% of the federal poverty level (FPL), prevent states from implementing new health insurance tax mechanisms to draw down federal dollars such as the recently enacted Managed Care Organization (MCO) tax in New York, among several others.
MSSNY also continues to work with a broad coalition of patient and health care provider groups from across New York State, including joining a host of sign on letters to members of New York’s Congressional Delegation including NY-Delegation-Letter-Protect-Medicaid-January-2025.pdf and https://medicaidmattersny.org/wp-content/uploads/2025/05/NY-Delegation-Letter-Protect-Medicaid-April-2025.pdf, urging them to oppose proposed cuts to Medicaid and other essential publicly financed health insurance programs.
2025 NY Legislative Session Brings Many Positives for Physicians, Some Challenges, and a Big, Big Remaining Question from Washington
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MSSNY’s Morris Auster, Esq. breaks down the highs, hurdles, and the looming federal wildcard shaping NY healthcare. Get the insider’s take on what it means for your practice.
AMA, 78 Medical Societies Back Vaccination Against Respiratory Viruses
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With respiratory viruses expected to surge this fall and ahead of the Advisory Committee on Immunization Practices (ACIP) meeting this week, MSSNY joined the American Medical Association (AMA) and nearly 80 medical associations across the country in a letter reaffirming their collective support for vaccination as the best way to protect against the flu, COVID-19, and RSV and their potentially serious complications. The organizations call on partners—insurers, hospitals, and public health agencies—to ensure these life-saving vaccines remain available to patients without cost sharing.
Have You Checked Out the MSSNY CME Website Lately?
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MSSNY CME can help you prepare for the next disaster. Of particular interest is the Emergency Preparedness module Nuclear Radiation and Blast Injuries 2024 Update and Medical Matters: Disaster Preparedness: Every Physicians Second Specialty will provide valuable information on how to be ready for some of the most pressing disaster concerns right now. And, with more than 70 courses available, there’s sure to be something of interest for everyone!
CMS Alert Highlights Medicare Fraud Scheme Involving Phishing Fax Requests
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The Centers for Medicare & Medicaid Services (CMS) published an alert on fraud schemes that are increasingly targeting Medicare providers that involve bad actors impersonating CMS and sending phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit.
Phishing is an example of social engineering that attempts to trick you or someone else in your workplace into giving out sensitive information. Email phishing attacks are still a common occurrence, but we are hearing about more fraudulent fax requests being sent out to medical practices by bad actors.
CMS emphasized that it does not initiate audits by requesting medical records via fax. We urge physicians and practices to take steps to protect their data.
If physicians receive a suspicious request, do not respond. CMS encourages you to work with your Medical Review Contractor if you receive a questionable or suspected fraudulent request to confirm if it is real.
NYRx Updates Diabetic Testing Supply Guidelines: What Physicians Need to Know
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New updates from NYRx outline specific parameters for pharmacies and prescribers managing diabetic testing supplies for Medicaid patients. Physicians must follow new quantity and day supply limits for diabetic test strips and lancets, 300 strips per 90 days for insulin users and 100 for non-insulin users, aligned with Medicare standards. Prescriptions exceeding these thresholds will require prior authorization. Continuous glucose monitors and disposable insulin pumps must also be billed in accordance with labeling guidelines. MSSNY encourages New York physicians to review the NYRx Preferred Diabetic Supply Program and ensure their prescriptions meet these updated criteria. By doing so, physicians help patients avoid unnecessary delays while preserving access to essential care. Stay informed and connect with MSSNY’s advocacy and policy updates to support your patients and your practice. Learn more: NYRx Diabetic Supply Resource
Secure Your Financial Future: Join MSSNY for Our Exclusive PLIP Webinar
New York physicians face unique financial challenges, from navigating high medical school debt to managing practice liabilities in a complex healthcare landscape. MSSNY offers a powerful solution through its Physician Life Income Plan (PLIP), a premier member benefit spotlighted in Forbes and MD News for its innovative approach to retirement planning. On July 15, 2025, MSSNY invites you to an informational webinar to explore how PLIP empowers physicians with tax-deferred growth, tax-free withdrawals, and full creditor protection—features tailored to secure your financial future. Unlike traditional retirement plans, PLIP offers unmatched flexibility with no contribution limits, over 80 investment options, including the S&P 500, and 100% liquidity for immediate access to funds.
Create Lasting Memories with Exclusive MSSNY Member Discounts on 2025 NY Mets Games!
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MSSNY members, get ready to make unforgettable memories with family and friends at Citi Field! Thanks to our exclusive partnership with the New York Mets, you can enjoy special discounts on select 2025 games, including the upcoming Subway Series! Act fast, seats are limited!
