MSSNY Secures $17 Million Wrongfully Withheld from NY Physicians by Health Insurance Plans
Friday, September 5, 2025
The Unraveling of the CDC and the Rise of State-Based Public Health Directives
Click to Enlarge
Colleagues:
The events of the past month threaten to undo a century of progress in public health.
On August 8, a gunman fired more than 500 rounds into the Centers for Disease Control and Prevention (CDC) headquarters in Atlanta. His stated motive was to “make the public aware of his distrust of vaccines.” Officer David Rose, a local police officer who responded heroically, was killed. The gunman took his own life. Thankfully, no one else was injured.
Less than three weeks later, on August 27, the White House dismissed CDC Director Susan Monarez. Five of the CDC’s top leaders immediately resigned in solidarity. Within days, states began charting their own divergent paths. Washington, Oregon, and California announced the creation of a West Coast Health Alliance to provide evidence-based recommendations on immunizations and vaccine safety. Meanwhile, Florida moved in the opposite direction, preparing to allow residents to opt out of all vaccine mandates.
Taken together, these events reveal a disturbing trajectory: violence against public health institutions, political pressure undermining scientific expertise, and a growing patchwork of state-based vaccine rules.
A Dangerous Polarization of Medicine and Public Mistrust
Medicine is at risk of becoming red-state and blue-state practice, while it should be based on science and objective evidence. Physicians may find themselves not only explaining the science but also battling political perceptions that frame their advice as partisan. In such an environment, the wrong word can cause a patient to dismiss sound medical guidance as “politically biased.” Worse, physicians may face ostracism, threats, or even violence.
Medicine should rise above politics. When a child is sick, or when a vaccine prevents deadly disease and protects newborns too young to be immunized, public health should unite us. Instead, political polarization and social media platforms that amplify distrust have eroded confidence in physicians and hospitals. According to a recent JAMA Network Open survey, public trust in these institutions has fallen below 50 percent.
Restoring Trust
While the unprecedented measures taken during COVID-19 pandemic meant to stop the rapid spread of the disease meant well, some of the measures taken and affirmative and absolute claims made by political and public health officials turn out not to be based on solid and validated scientific evidence. The unintended consequences of these actions and claims unfortunately caused mistrust of public health and medical professionals when it comes to immunization. Rebuilding that trust will not be quick or easy. It will require diligence, empathy, humility, political skill—and unfortunately, money. In the exam room, physicians must meet patients where they are: listening first, giving them space to process, and respecting their need to “do their own research,” then offering their professional opinion. We need to go back to the basics of physician-patient relationship and communication without injecting our personal politics.
At the state level, public health leaders must continue to advocate for evidence-based policy, even while addressing public skepticism. Federally, we must be careful not to present science as immutable dogma. Instead, we should state clearly: these recommendations are based on the best available science today. It is important to transparently lay out the risks, benefits, and alternatives, if any, of any treatment we offer our patients. However difficult, restoring trust is essential for the health of our patients.
A Call for Leadership
The actions of the past month are unacceptable. Leadership matters, and accountability matters. HHS needs to objectively analyze data and publish reasonable guidelines in a way that restores credibility and stability. Fragmentation of our public health policies will only set us back and should be avoided. Public health officials must be committed to science, public health, and rebuilding trust across the political spectrum, and be held accountable.
In the meantime, Senator Bill Cassidy, who chairs the Senate Health, Education, Labor, and Pensions Committee, should exercise rigorous oversight of federal health agencies. If the federal government cannot maintain credibility, states will continue to fracture along partisan lines—leaving Americans with unequal and uncertain access to public health protections.
Standing Firm
Physicians across the country are practicing medicine under extraordinary pressure. They are heroic for continuing to serve patients in this volatile environment. But they cannot do it alone. Professional organizations, policymakers, and communities must stand with them.
We cannot remain silent while public health is politicized and trust in medicine erodes. The integrity of our health system—and the safety of our patients—depend on it.
All the best,
David Jakubowicz, MD, FACS
MSSNY President
MSSNY Secures $17 Million Wrongfully Withheld from New York Physicians by Health Insurance Plans
Click to Enlarge
For New York physicians, dealing with insurers, regulators, and endless administrative roadblocks is a daily reality. MSSNY’s Payment & Practice Division is revolutionizing the landscape for our members, having successfully recovered over $17 million since 2021 through dedicated advocacy, strategic appeals, and effective intervention. This remarkable achievement underscores our unwavering commitment to supporting healthcare professionals and ensuring they receive what they rightfully deserve.
Led by Heather Lopez, VP of Payment & Practice, the division has completed more than 2,300 consults for New York physicians. It has tackled everything from late insurer payments and credentialing delays to improper takebacks, denials, and downcoding errors. Each case represents money and time put back into physicians’ practices so they can focus on what matters most: patient care.
Beyond direct recovery, MSSNY has delivered statewide wins for all physicians, including preserving free excess malpractice coverage for 16,000 doctors, securing telehealth payment parity, blocking mid-year formulary changes, and helping increase Medicaid E&M payments. The division also plays a critical role in national advocacy, working with the AMA and regulators to oppose Medicare cuts and insurer payment schemes.
At a time when financial pressures and administrative burdens are pushing more physicians out of independent practice, MSSNY stands firm in protecting both your livelihood and your profession. If you’re not yet a member, now is the time to join and ensure you have an advocate working tirelessly on your behalf.
Important Information from the New York State DOH About Required and Recommended Vaccines
Click to Enlarge
At a time when some states are confoundingly seeking to weaken immunization requirements that threaten our collective efforts to prevent and contain communicable diseases, MSSNY strongly supports the New York State Department of Health’s continued effort to protect public health through promotion of the importance of obtaining recommended and required vaccinations. The MSSNY House of Delegates has adopted numerous policies emphasizing the importance of vaccines for achieving “herd immunity” against preventable diseases, including Policy 30.995 Immunization of Adolescents , Policy 312.973 Childhood Vaccinations and 260.875 MSSNY Principles of Public Health During an Infectious Disease Outbreak.
Here are important links to information from the New York State Department of Health about required vaccinations for children and recommended vaccinations for adults:
Harnessing Digital Tools to Transform Patient Care: Dr. Antigone Argyriou’s Insightful Session
Click to Enlarge
Digital innovation is reshaping medicine, offering physicians new ways to educate patients, enhance care delivery, and build stronger provider–patient relationships. In a recent installment of Women in Medicine: MSSNY’s Empowering Educational Series, Antigone Argyriou, MD, FAAPMR, a MSSNY member since 2015, shared her expertise in the session “How Digital Tools like Social Media Can Enhance Patient Education, Improve Care Delivery, and Empower Patients and Providers.”
Dr. Argyriou, a board-certified physiatrist and medical leader, explored how platforms such as social media and telehealth are more than communication tools. They are essential drivers of accessibility, trust, and empowerment in modern healthcare. Her lecture emphasized practical strategies for physicians to leverage technology responsibly, helping patients better understand their health while streamlining clinical workflows.
With a career spanning clinical practice, academic leadership, and patient advocacy, Dr. Argyriou brings professional depth and a human touch to the conversation. Her long-standing involvement with MSSNY reflects her commitment to advancing physician voices and ensuring patient-centered care across New York.
This educational session is now available on demand through the Women Physicians Section page, under Women in Medicine: MSSNY’s Empowering Educational Series.
Remembering Gerard “Gerry” Conway: Architect of Physician Advocacy in New York
Click to Enlarge
It is with great sadness that we report the passing of Gerard (“Gerry”) Conway who was the Chief Legislative Counsel for the Medical Society of the State of New York for decades until his retirement following the 2012 Legislative Session.
Many longtime physician leaders, MSSNY staff and county society executives will recall with great fondness Gerry’s wisdom, wit and warmth. A long-time writer and grader of the New York State Bar exam, he had an encyclopedic knowledge of New York’s healthcare system. He was a mentor to dozens of MSSNY lobbying staff, all of whom were distraught to learn of the passing of this wonderful human being, recounting the stories and folksy expressions Gerry regularly spoke.
Professionally, he was the architect of numerous laws enacted in New York that helped to protect the ability of physicians to deliver care to their patients, including the passage of several laws in the mid-1970s and mid-1980s to respond to the liability crises occurring at that time which literally threatened to shut down our healthcare system. He played a critical part in the development of landmark managed care reform laws in the 1990s, including the Prompt Payment law, the External Appeal law and the Patients’ Bill of Rights.
He also played an essential role for MSSNY’s annual House of Delegates meeting, helping to provide critical insight to the delegates in the shaping of policy resolutions to help ensure they were written in a way that helped to achieve their goal.
He is survived by his wife Helen, 5 children and numerous grandchildren. A private service is planned in Florida with a public memorial service to occur in Albany sometime over the next few months.
Shape the Future of Medicine: Join a Committee and Make Your Voice Heard
Click to Enlarge
Take an active role in shaping the future of your profession. Join a MSSNY Committee today! This is your opportunity to make a real impact, collaborate with peers, and bring your unique perspective to the table. The deadline to sign up is Tuesday, September 30, at 4:00 PM. Don’t miss your chance to influence key issues and help advance the medical community. Submit your Committee Volunteer Form now and be a part of the change you want to see.
Physicians Advocate for their Profession Through Local Political Event
Click to Enlarge
Numerous MSSNY and MSSNYPAC Physician Leaders recently participated in a campaign event for NYS Assembly Member Michaelle Solages (AD-22), Chair of the New York State Black, Puerto Rican, Hispanic and Asian Legislative Caucus. Joining Assembly Member Solages (first row center) at the event are Dan Haller, M.D., Thomas Lee, M.D., Michael Brisman, M.D., and MSSNY President David Jakubowicz, M.D. Also attending the dinner program were (back row, left to right): Margaret Lee, Benjamin Cohen, M.D., Sean McCance, M.D., Shahriyour Andaz, M.D., Daniel Choi, M.D., and Sarah Brisman.
Photo Credit: NSPC Marketing Department
Attorney General James Secures Settlement with MVP Health Plan Over Mental Health Ghost Network: MVP to Adopt Reforms to Improve Patient Access to Mental Health Care
Click to Enlarge
New York Attorney General (AG) Letitia James announced an agreement with MVP Health Plan (MVP) to overhaul its mental health provider directory to ensure the accuracy of its mental health provider network and provide compensation to MVP members impacted by the directory’s inaccurate listings. The settlement follows an investigation by the Office of the Attorney General (OAG), which was launched in 2023, that uncovered systemic issues within MVP’s network, including incorrect directory information, that left some members unable to access care or forced them to pay out-of-pocket for out-of-network treatment. The agreement is the first action resulting from AG James’ report, “Inaccurate and Inadequate: Health Plans’ Mental Health Provider Directories.” Read the full report.
The OAG launched its investigation in 2023 and conducted a secret shopper survey of mental health providers listed in MVP’s online directory. The survey found that 100% of the mental health providers it called, all of whom were listed as “accepting new patients,” were either unreachable or not currently accepting new patients, and that MVP had no process in place to routinely verify providers’ availability.
MVP must provide financial compensation to eligible members who overpaid because of inaccurate provider listings or a lack of available in-network providers since January 1, 2020. An OAG-approved compliance administrator will oversee the process, and MVP must notify eligible members and post claim submission information on its website. In addition, MVP will pay $250,000 in penalties, fees, and costs to the state of New York.
This year is the 20th anniversary of New York’s passage of mental health insurance parity — Timothy’s Law. Read AG James’ statement about the settlement.
You Asked, NGS Listened – Introducing the Modifier Lookup Tool
Click to Enlarge
National Government Services (NGS) values the feedback of our providers and uses it to improve your experience continuously. NGS is excited to announce the launch of the Modifier Lookup Tool, designed to give you fast and reliable information on most Medicare procedure code modifiers.
How It Works
Simply enter the required fields:
- Modifier
- Procedure Code
- Type of Service
- Date of Service
Then click Search.
What You’ll See
For valid procedure code/modifier combinations, the tool displays:
- Short Description – an abbreviated description of the modifier.
- Statistical Modifier Indicator
- S = Statistical
- P = Pricing
- Effective Start and End Dates (if applicable)
- Units – including any reduction percentage for the code/modifier combination
- Payer Information – determines pricing/action taken:
- N = No pricing action
- P = Multiply by percentage
- U = Add units to RVUs
- S = Substitute RVU
- D = Added dollars
- M = Multiply RVU
- C = Substitute RVU conditionally
- Second Modifier Indicator
- I = Invalid in second modifier position
- V = Valid in second modifier position
Urgent for Physicians: How HR 1 and Medicare Pie-Shifting Could Affect Your Practice
Click to Enlarge
As physicians navigating a shifting healthcare landscape, it’s crucial to understand how proposed federal legislation—like HR 1—and emerging trends in Medicare pie-shifting may directly impact your practice revenue and patient care. Listen to the latest MSSNY podcast as we break down what’s at stake and how you can join MSSNY’s coordinated advocacy efforts.
