Insurance Payment Issues? Your Physician Colleagues Share Insight
Friday, February 14, 2025
Punching Above Our Weight
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Colleagues:
This has been a big week for our lobbying efforts. Kudos to all who came to DC for the AMA National Advocacy Conference or visited Albany the same days for the Budget Hearings. I would like to share a personal vignette with you. We were in Senator Schumer’s office reiterating the urgent need for reversing the recent Medicare cuts and preventing future Medicaid cuts, to which the aides were offering the usual “The Senator shares your concerns…” To amplify my concerns, I referenced an alarming situation reported to me from a physician’s office regarding a managed care plan that was planning to drop their payments well below even Medicaid rates.
The rationale for the cuts was the uncertainty in Congress about future Medicaid funding. Never mind that such cuts have not yet happened, this company was acting now. That got the aide’s attention.
We made additional points that this was a concrete real-time example of how insurance companies are now acting. We said consolidation has resulted in the survival of only a few companies that now wield monopolistic power and present “take-it-or-leave-it” contracts with terms that are economically unsustainable. In addition, cumulative cuts and failure of payments to keep up with inflation have devastated practices. We also urged that any pending Medicaid cuts be done “surgically” so as to cut out the real fat and otherwise preserve physician payments.
Thankfully the company retreated from its plan to slash their payments to this physician office. Quite frankly, I must say that the result was perhaps more due to Heather Lopez’s efforts as our MSSNY insurance ombudswoman who was working behind the scenes to help this Clinic, and maybe less related to our lobbying earlier that day. Either way, whether it was from MSSNY staff advocacy with the insurer, or MSSNY lobbying that put this ball over the top, the bottom line is that MSSNY is in your corner fighting for you.
In DC, the big issues are Medicare payment reform and good prospects this year for a retrospective 2% increase and preserving physician practice payments despite looming Medicaid cuts. In Albany, we are lobbying hard for preservation of the dispute resolution process for resolving Medicaid managed care plan underpayments, workers comp issues, restoration of cuts to the Excess Medical Malpractice insurance layer, prior authorization, and scope of practice issues, among others.
All of this also takes money, both in terms of additional dues dollars to fund our advocacy efforts and in political activity. Both MSSNYPAC and AMPAC need your donations now. Our funds are low, and we are being vastly outspent by the insurance companies, drug companies, and PBM groups. Your leadership is doing all we can with our physical presence, but we need your help from back home with donations to the PACs. We are seeing results that surpass what should otherwise be expected with our limited resources. In that sense, we are punching above our weight. Imagine what we could accomplish if more physicians became members, and if more donated to the PAC. By the way, one does not have to be a member of MSSNY to donate to MSSNYPAC. So, if you are from outside NY and you are reading this message, yes, we would welcome your donations too. Click here to donate to MSSNYPAC.
Also, our Lobbying Day in Albany is scheduled for Tuesday March 11. Do come. For more information and to register today, click here.
All the best,
Jerome C. Cohen, MD
MSSNY President
Insurance Payment Issues? Elevate Your Practice with MSSNY’s Physician Payment and Practice Service
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MSSNY’s Physician Payment and Practice Services are your trusted partner in overcoming healthcare’s administrative and financial hurdles. With a proven track record of recouping millions for members, our service provides tailored solutions to address insurance payment denials, network issues, and operational challenges. From private practices to large healthcare systems, MSSNY is committed to advocating for your success.
Don’t just take our word for it—hear from fellow physicians who have benefited:
“I had been trying for three years to establish communication with a major insurance provider regarding my network status, with no success. Heather not only managed to get me in direct contact with the right people, but she also facilitated the process in a way that led to a complete reversal of their previous decision. Thanks to her dedication, expertise, and advocacy, I was able to rejoin the network—something I had almost given up on. I am truly grateful for her exceptional service, persistence, and professionalism. I highly recommend her to anyone in need of strategic guidance and industry connections.”
– Ankur Shah, MD, Cardiovascular Disease
“I have had the pleasure of working with Heather Lopez over the past two years to address insurance payment denials in my small private practice, and I can honestly say she is one of the best professionals I have ever worked with. Heather is incredibly organized and always stays on top of follow-ups, ensuring that nothing slips through the cracks. Whenever we received an incorrect payment denial, our office would reach out to the insurance company for clarification on the reason. After going through the typical appeal process without success, Heather became my go-to resource. She has valuable contacts within these companies who not only listen but actively work to resolve issues. Thanks to her expertise and determination, we have even succeeded in getting insurance companies to update outdated policies that contributed to these denials. I highly recommend Heather to any small medical clinic. She is truly one of the few professionals I’ve encountered who is genuinely on the side of physicians and understands the complexities of insurance challenges. Working with her has been a game-changer, and I am extremely grateful for her support.”
– Qiao D. Guo, MD, Anesthesiology
“As a private practice practitioner in New York, one of the biggest ongoing challenges to remaining in private practice is managing payments or lack thereof from insurance carriers. Through MSSNY, Heather Lopez has been an utterly invaluable source of assistance in matters related to inappropriate attempts at claw back of previously paid funds as well as inappropriately low payments that are not consistent with my contracts. She has affected reversal of many thousands of dollars of erroneous claw backs as well as correction of underpayments that would have negatively affected my practice both financially and in terms of the time I might have had to apportion to dealing with the matter. Even with my best efforts, I may never have achieved a just outcome against a monolithic insurance carrier.
In one particularly illustrative instance, an insurance carrier attempted an inappropriate claw back of a previous underpayment for a service. Not only did Heather Lopez’s efforts result in reversal of the claw back, but the insurance carrier admitted that the initial payment was an underpayment and corrected it. As a private practitioner, this outcome would simply not have been possible without her involvement.
As such, I cannot recommend her enough. This service that is provided by MSSNY through Heather Lopez shows that MSSNY understands the plight of those of us who push forward in private practice because we feel that it represents the best avenue through which we can serve our patients. Her assistance has, on multiple occasions, made me feel as though I suddenly had a voice in an arena where I had previously felt silenced. It has given me the fortitude to continue my attempts to serve the people of New York.”
-Ksenija Belsley, MD, FACS
MSSNY’s services extend beyond claims assistance, offering regulatory support and guidance to ensure compliance and financial stability. Whether you’re a member or considering joining MSSNY, take the first step toward protecting your practice.
Contact [email protected] or call (518) 328-3532 today. Let MSSNY advocate for your success.
Vision Risks Associated with GLP-1 Medications Under Investigation
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A recent study published in JAMA Ophthalmology highlights potential vision risks associated with GLP-1 medications such as semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro, Zepbound). Conducted by researchers, including a neurologist from the University at Buffalo, the study explores cases of sudden vision loss linked to these drugs. Nine patients experienced conditions like nonarteritic anterior ischemic optic neuropathy (NAION), a condition caused by insufficient blood supply to the optic nerve, resulting in partial and often permanent vision loss.
While these cases remain rare, concerns are rising as the use of these medications, primarily for diabetes and weight loss, continues to grow. The patients studied had other health conditions, such as diabetes and cardiovascular issues, which may independently increase the risk of vision problems. Researchers are investigating whether the rapid blood glucose reductions caused by these drugs could exacerbate these risks.
The study emphasizes the importance of prompt action if patients experience vision changes while taking these medications. Physicians should encourage patients reporting blurred or lost vision to consult an ophthalmologist immediately. Patients should not discontinue medication without consulting their healthcare provider, as GLP-1 medications provide significant benefits for managing diabetes and obesity.
The researchers and the American Academy of Ophthalmology are advocating for a post-marketing survey to better assess the prevalence of these ocular side effects. This initiative aims to provide more straightforward guidance to physicians and patients regarding the safe use of these increasingly popular medications.
Ophthalmic complications in patients on antidiabetic GLP-1 medications are concerning neuro-ophthalmologists (Goldbaum, UBNOW, 2/7).
NSPC Brain & Spine Surgery Ranked #1 Neurosurgery Practice in New York
Michael H. Brisman M.D., F.A.C.S., the CEO of Rockville Centre, NSPC
MSSNY Member Since 1998
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NSPC Brain & Spine Surgery (NSPC) has been ranked as the #1 neurosurgical practice in New York State for the second consecutive year by Castle Connolly, a New York City research and information company. NSPC was one of the physician practice groups recognized in a national awards survey called the 2025 Castle Connolly Accolades.
Last year, in the same survey, Castle Connolly ranked NSPC among the top five practice groups in the U.S. and as the #1 neurosurgery practice in New York.
When Castle Connoly introduced its Accolades survey in 2024, Steve Leibforth, the firm’s managing director, said it was created “to recognize multiple institutions – ranging from health systems providing comprehensive care to an entire region, to community-based physician practices excelling in specific and specialized care. The institutions all employ exceptional physicians who have been recognized as Castle Connolly Top Doctors, ensuring the highest quality care for their patients.”
“We are honored to have been ranked, again, by Castle Connolly as the top physician practice in New York,” declares Michael H. Brisman M.D., F.A.C.S., the CEO of Rockville Centre, NY-based NSPC. “This achievement,” he asserts, “confirms our group’s 67-year commitment to personalized patient care and excellence in spine and brain surgery.” NSPC is Long Island’s largest, independent neurosurgical group with 12 experienced neurosurgeons and seven conveniently located offices on Long Island offices and in Manhattan.
The NSPC Castle Connolly “Top Doctors” are: Jonathan L. Brisman, M.D. (Cerebrovascular, Spine and Brain Surgery), Benjamin R. Cohen, M.D (Spine Surgery), Vladimir Y. Dadashev, M.D. (Spine Surgery), Zachariah M. George, M.D (Spine Surgery), Yusef Imani, M.D. (Spine Surgery), Stephen T. Onesti, M.D. (Spine Surgery), and Sachin N. Shah, M.D. (Spine Surgery).
For decades, Castle Connolly has been conducting a peer-review survey to select the region’s top doctors based on the theory that medical professionals are best qualified to assess the qualifications of other practitioners. Licensed physicians vote online for those doctors they consider outstanding. A Castle Connolly doctor-led research team then counts the nominations and vets the nominee pool with the aid of several screens, including confirming board certifications and investigating disciplinary histories. In 2020, Castle Connolly was acquired by the Everyday Health Group, a division of J2 Global Inc.
Judge or Visit MSSNY’s Poster Symposium
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MSSNY will again host an in-person Poster Symposium during the House of Delegates at the Westchester Marriott in Tarrytown. The symposium is scheduled for 12:00 – 3:00 PM in the Terrace Room. If you are available and would be interested in judging the posters, please contact Kathy Rohrer at [email protected]. If you are unavailable to serve as judge, we strongly encourage you to stop by and visit with the Residents and Students.
MSSNY Testifies on Key State Budget Priorities to Protect Patient Access to Community-Based Physician Care
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This week, MSSNY Immediate Past-President Paul Pipia, MD, testified at a joint Senate-Assembly hearing examining the Healthcare portion of the Governor’s Executive Budget. Click here Joint Legislative Public Hearing on the 2025 Executive Budget Proposal to view Dr. Pipia’s testimony as well as his follow-up to several questions posed by legislators on the panel.
His testimony focused on the numerous proposals impacting medical care delivery in Executive Budget proposal for the 2025-26 Fiscal Year. He noted that, while the Budget contains some positive measures, it also contains several seriously problematic initiatives that MSSNY will work with numerous allies to oppose.
MSSNY Continues to Strongly Oppose:
- Requiring physicians to pay 50% of the Excess Medical Malpractice Insurance cost – a $40,000,000 imposition on the 16,000 physicians with Excess coverage, which would be on top of the already outrageously high medical liability insurance premiums they already pay. Please send a letter opposing this measure here: Reject Physician Cost-Share for Excess Insurance Program
- Eliminating the right of physicians to appeal Medicaid Managed Care underpayments to IDR. This provision could further impair the ability of hospitals to maintain already strained on-call specialty care services. Please send a letter opposing this measure here: Retain Physicians’ Right to Use Independent Dispute Resolution Process in Medicaid Managed Care Claims
- Eliminating the historical role of county medical societies in vetting physicians to participate in the Workers’ Compensation (WC) program. This proposal does not meaningfully address the reasons physicians refrain from participation in WC and could result in some situations where an injured worker’s claim is impeded due to lack of sufficient knowledge of the often-cumbersome WC process. Please send a letter opposing this measure here: Preserve Role of County Medical Societies in Workers’ Compensation Application Process
- Eliminating the requirement for physician supervision of the healthcare services provided by Physician Assistants (PAs) despite legislation enacted last year (and not even effective until mid-February) to significantly expand the responsibilities of PAs. Please send a letter opposing this measure here: Preserve Physician-led, Team-based Healthcare
- Permitting psychiatric NPs to certify involuntary commitment of patients.
- Permitting pharmacists to prescribe and order medications to treat nicotine dependence.
- Increasing prior authorization burdens in Medicaid by eliminating “prescriber prevails” protections in Medicaid.
MSSNY Supports:
- Funding for MSSNY’s Committee for Physicians Health (CPH) program.
- Funding to help increase woefully inadequate Medicaid physician reimbursement.
- Addressing the unworkable provider financial consent requirement enacted last year (currently “on hold”) that consent for payment from the patient be received after services are delivered.
- Directing DOH to undertake a comprehensive review of New York’s outdated health plan network adequacy standards.
The problematic initiatives included in this Budget proposal is another critical reason for physicians to come to Albany for the Annual Physician Advocacy Day on March 11.
MSSNY Physician Leaders and Staff Meet With New York Congressional Delegation on Capitol Hill to Discuss Urgent Need to Fix Medicare Payments to Physicians
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MSSNY physician leaders and staff conducted meetings with several members of the New York Congressional Delegation in DC this week, to urge immediate action by Congress to update woefully inadequate Medicare payments to physicians, particularly in light of the 2.8% cut that went into effect January 1.
The physicians urged support for the Medicare Patient Access and Patient Stabilization Act of 2025 (H.R.879), which would reverse the latest round of Medicare payment cuts and provide an inflationary update to ensure payments in 2025 start to the rising costs of delivering care. MSSNY also urged support for a similar proposal in a potential health-related package in the Continuing Resolution (CR) to keep the government funded, which expires in March.
Physicians face a 2.8% cut in Medicare payments in 2025 — the fifth consecutive year of cuts—while the cost of running a practice continues to rise. The Centers for Medicare & Medicaid Services (CMS) estimates that the Medicare Economic Index (MEI), which reflects practice cost inflation, will increase by 3.5% in 2025, yet physician payments continue to decline. Physicians’ Medicare reimbursement has now been reduced by 33% since 2001 when adjusted for inflation in practice costs.
Payment cuts could also force many physicians to limit the number of Medicare patients they treat, jeopardizing access to care for untold numbers of New Yorkers with Medicare. These cuts will be felt hardest by small, independent practices, such as those in rural and underserved communities.
MSSNY physician leaders that participated in Hill visits included:
Jerome Cohen, MD, MSSNY President
David Jakubowicz, MD, MSSNY Pres-Elect
Mark Adams, MD, MSSNY Vice-President
Dr. Louis Auguste, MD
Michael Brisman, MD
Harman Chopra MD
Luella Lewis MD
Thomas Lee, MD, MPH, MSSNY EVP
Jessica Krant MD, MPH
Sophia Spadafore, MD
Stephanie Eng, MD
Gregory Pinto, MD
Allana Krolikowski, MD
Willie Underwood, MD, MSc, MP
Meetings were held with:
Representative Tom Suozzi
Representative Hakeem Jeffries
Representative Dan Goldman
Representative Nicole Malliotakis
Representative Yvette Clarke
Representative Joseph Morelle
Representative Paul Tonko
Representative Claudia Tenney
Representative Nicole Malliotakis
Representative Nick Langworthy
Representative Alexandria Ocasio-Cortez
Senator Charles Schumer
Senator Kirsten Gillibrand
MSSNY will continue to monitor and advocate on members’ behalf on these issues and provide updates as available.
Capital Update: February 14, 2025
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MSSNY Joins Societies in Urging Reversal of Medicare Payment Cuts
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The Medical Society of the State of New York is among the state medical societies and health care organizations calling on lawmakers to reverse cuts to Medicare payments to physicians. “America’s physicians are united in urging Congress to use the forthcoming March appropriations bill as an opportunity to provide physicians with desperately needed fiscal relief that is imperative to ensuring that seniors retain access to health care services under Medicare,” they wrote in a letter to legislators.
Full Story: Becker’s ASC Review (2/10)
Medical Society Applauds Governor Hochul for her Efforts to Protect Physicians Providing Care to their Patients from Inappropriate Legal Actions from Out of State Officials
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“We again applaud Governor Hochul for her efforts to protect New York physicians providing care to their patients from inappropriate legal actions from out of state officials.
“The MSSNY House of Delegates has adopted policy 5.990 Protecting NYS Practitioners Delivering Contraception and Abortion Care to protect practitioners licensed and residing in New York from legal or personal liability when delivering healthcare services to residents of New York State or any other state, whether in person or via telemedicine, when the services provided comply with New York State laws and regulations.
“We will continue to fight for the right of our physicians to provide the care our patients expect and deserve.” Read more.
MSSNY Physician Leaders Fight for their Profession and Patients in Albany and Washington
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Listen to ‘MSSNY Physician Leaders Fight for Their Profession and Patients in Albany and Washington‘ for an inside look at how physician advocates are shaping healthcare policy at the state and federal levels.
Virtual Drill: An In Depth Look at Recovery
In 2024, there were more than 488 mass shootings as well as 27 major weather events that caused 568 fatalities. Now that 2025 has started, what responses have been deployed to assist in recovery from these events? Are you aware of best practices to disseminate recovery resources? Learn more about responding to a scenario and how recovery comes about by registering for Virtual Drill: An in Depth Look at Recovery on February 26th at 7:30am. Craig Katz, MD, Chair of MSSNY’s Emergency Preparedness & Disaster/Terrorism Response Committee and Tom Henery, Preparedness Training Manager, New York State Department of Health, Office of Health Emergency Preparedness, will serve as faculty for this webinar. Register now.
Educational Objectives are:
- Analyze a scenario of a public health emergency and best practices for recovery at the systems and individual level.
- Outline information about local, state, and national chain of command in a public health emergency and learn how to access resources for recovery.
- Recognize and apply the principles of psychological first aid.
- Relate the importance of planning and preparation for the aftermath of a public health emergency.
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at [email protected].
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Navigating the Independent Dispute Resolution Process
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Join us February 24, for an essential webinar on understanding the Independent Dispute Resolution (IDR) process under the No Surprises Act and New York’s No Surprise Law. This session will help physicians dispute inadequate reimbursements for out-of-network surprise bills, ensuring fair compensation. Learn the key steps for navigating IDR, evaluating claims, and protecting your practice’s financial health. Don’t miss this opportunity to take control of your reimbursement process. Register now.
Women Physicians Leadership Academy Returns in March
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The MSSNY Medical Educational and Scientific Foundation (MESF) Women Physicians Leadership Academy, led by Dr. Tochi Iroku-Malize, continues with two empowering virtual sessions: Enhancing Physician Wellness and Wellbeing on March 2 and The Importance of Networking on March 15. These sessions offer actionable strategies for career advancement, leadership growth, and professional well-being. Physicians who complete all three sessions will earn up to nine CME credits. Secure your spot and invest in your leadership journey today.
Flipping the Script: How to Put Tax Dollars Back into Your Pocket
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There are tons of legal tax strategies that doctors can use to reduce their annual tax bill during their working years, and later into retirement.
In the case of tax codes, what you don’t know really can hurt you! Join Altfest experts on March 5th at 12 PM as they crack open their tax planning playbook to cover:
- How to lower you tax burden
- Preparing for pending tax code changes
- Example tax scenarios in action
Secure Your Financial Future with MSSNY’s Physician Life Income Plan (PLIP)
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MSSNY is proud to feature the Physician Life Income Plan (PLIP) as a premier member benefit, spotlighted in Forbes and MD News for their approach to retirement planning. PLIP is a tailored financial solution that empowers physicians to maximize tax-deferred growth, enjoy tax-free withdrawals, and protect assets from creditors — all while bridging the retirement gap with unparalleled flexibility and security.
With no contribution limits or early withdrawal penalties, PLIP stands apart from traditional retirement plans. Members can reallocate current investments, such as cash, CDs, or cash value life insurance, into a tax-advantaged vehicle that offers over 80 investment allocation options, including indexes like the S&P 500. All funds in PLIP grow tax-free, are withdrawn tax-free, and pass to beneficiaries tax-free.
Additional benefits include 100% liquidity, ensuring members have immediate access to their funds with no holding periods or surrender charges. MSSNY physicians will benefit from complete creditor protection for their PLIP assets, safeguarding financial stability against unforeseen challenges.
