THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



Session to detail practice-affecting insurance changes

Christopher Phillips, MD
Christopher Phillips, MD

Keeping up with the sometimes arbitrary changes in health insurance policies are just one of the administrative aspects of being a physician. Sunday’s Business/ Administration session Keep Up With Insurance Changes: How They May Affect Patients will cover the latest trends and changes in health insurance coverage.

Christopher Phillips, MD, a rheumatologist in Paducah, KY, and Chair of ACR’s Insurance Subcommittee, will open the session with an update on insurance advocacy issues, and Gary Bryant, MD, from the University of Minnesota, will discuss navigating new insurance updates and trends during the session, which will take place from 4:30 – 6:00 pm in Room B308 of Building B of the Georgia World Congress Center.

“The Insurance Subcommittee triages complaints or reports that we get from ACR members about various issues they may be having with insurance companies and their policies,” Dr. Phillips said.

In his presentation, Dr. Phillips will focus on some of the biggest issues facing ACR members today, and what is being done to combat them.

Among the issues facing many rheumatologists, he said, is the use of consultation codes.

“This will not come as news to many, but UnitedHealthcare and Cigna have proposed or implemented elimination of consultation codes this year,” Dr. Phillips said. “ACR and other organizations have been working on this for our members.”

Gary Bryant, MD
Gary Bryant, MD

Another issue practices and patients are facing concerns site of service. For example, patients on infusion drugs are being required to move those treatments out of hospital facilities, in some areas, in favor of private clinics or home infusions.

“That is a cost savings for insurance companies, but we are trying to make sure people are maintaining access to needed services,” Dr. Phillips said.

Dr. Phillips will cover these and other issues during his talk, and will detail some of the efforts of the ACR and the Insurance Subcommittee on behalf of members.

“While our advocacy efforts are variably successful, it’s critical that we continue to dialogue with insurance companies regarding issues which affect our practices, and we want people to be aware of what we are seeing and know that we are willing to help out with these issues,” Dr. Phillips said.

During his presentation, Dr. Bryant will tackle some additional insurance updates and trends.

According to Dr. Bryant, there is an increasing administrative burden on rheumatology practices to follow payer rules and policies. This requirement is a significant financial burden on the practice and takes time and resources away from providing care for our patients.

“Despite this, rheumatologists take on this burden on behalf of our patients in order to find them the most appropriate care, and not to have excessive financial burden for them, which may lead to non-adherence to medications or missing visits that are important for their ongoing care,” Dr. Bryant said.

During his presentation, Dr. Bryant will discuss some of the important issues currently affecting rheumatology practices including payers asking providers to switch stable patients on infusions to biosimilars despite the FDA saying that biosimilars are not proven to be interchangeable.

Together, Drs. Phillips and Bryant hope to update attendees on all of these important topics and provide helpful resources and effective communication strategies for healthcare professionals discussing insurance issues with staff, patients and/or caregivers.