Problems with Insurance Companies Not Complying with SB112
First make sure your client's insurance was new or renewed after June 8, 2011. Then make sure it is not a self-funded plan. If both of those check out then go to http://insurance.ky.gov/ and on the left hand side panel there is a button that says file a complaint. You can either file it online or print the documents out and mail them in. The PT can do it on behalf of the patient, just ensure you check the boxes that correspond. The investigation should take no more than 30 days. Make a note on your calendar to follow up with the patient after 30 days. Typically the Kentucky Department of Insurance has been contacting the patient and not the PT with the results of the investigation.
KPTA Northern District 2nd Quarter Meeting Announced
January 26, 2012
6:00-8:00 p.m.
Membership: 62 PTs, 6 PTAs, 13 SPTs, 1SPTA
Meeting called by Vincent Oriolo DPT GCS
Attendees: Kentucky Physical Therapy Association, current and prospective Northern District members
Location: St. Elizabeth Florence ED Conference Room, 4900 Houston Road Florence, KY 41042
Directions: Park in the main parking lot, take the elevator to the lower level (floor 1) and follow signs to the ED Conference Room. Signs will be posted.
Contact: northernKPTA@gmail.com
KPTA Newsletter Posted
Click here to download Vol. 53, No. 4, November 2011 in PDF format.
KPTA On Facebook
Join the KPTA Facebook Group by clicking below:
http://www.facebook.com/groups/215057270642/
Senate Bill 112 News
FREQUENTLY ASKED QUESTION
Does the SB 112 impact co-pays for Medicare patients?
No. Medicare Advantage plans are NOT subject to this state law because federal statutes preempt “application of State law or regulations related to benefit requirements, requirements relating to inclusion or treatment by providers, coverage determinations (including related appeals and grievance processes), cost-sharing requirements, and requirements relating to marketing materials, summaries and schedules of benefits” to Medicare Advantage organizations.
According to current Medicare Advantage provisions, the federal regulations preempt all state laws and regulations except for licensure laws and laws related to plan solvency. Other than those two exceptions, state law does not apply.
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As of June 8th SB 112 will go into effect on new plans or plans that are renewed on or after June 8th.
(Example: If a company renewed their plan on May 15th, 2011 then their employees would have to wait until they renew in 2012 for the new co-pays to go into effect).
NOTICE TO ALL PT's: Please be aware of your patient's health plans to ensure that their co-pays are no more than that of their primary care doctor co-pay. The Kentucky Department of Insurance has told us that they rarely see a primary care doctor co-pay more than $25.00. If you see a co-pay more than $25.00, it should be a red flag. The Kentucky Department of Insurance wants us to report back to them if carriers are not following this new law so please contact KPTA's lobbyist, Leigh Ann Thacker, with any questions or concerns. All carriers have been notified of this new law and should be in compliance. In addition, ALL health plans that are sold in Kentucky are mandated to follow this law even if the carrier is not based in Kentucky.
Questions/Concerns: Contact Leigh Ann Thacker 502-594-9997 or thacker@sostrategy.com.
LANGUAGE OF SB 112:
AN ACT relating to occupational and physical therapy.
Be it enacted by the General Assembly of the Commonwealth of Kentucky:
SECTION 1. A NEW SECTION OF SUBTITLE 17A OF KRS CHAPTER 304 IS CREATED TO READ AS FOLLOWS:
(1) An insurer shall not impose a copayment or coinsurance amount charged to the insured for services rendered for each date of service by an occupational therapist licensed under KRS Chapter 319A or a physical therapist licensed under KRS Chapter 327 that is greater than the copayment or coinsurance amount charged to the insured for the services of a physician or an osteopath licensed under KRS Chapter 311 for an office visit.
(2) An insurer shall state clearly the availability of occupational and physical therapy coverage under its plan and all related limitations, conditions, and exclusions.
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