Cross Plan Petition 3 of 3

Dear Substance Use Treatment Provider:

Attached is Letter #3 : addressed to Sherry Rouillard at the Department of Managed Health Care.

The letter address the illegal use of cross plan offsets by health plans, like UnitedHealthcare. In essence, a health plan saying you owe them for an overpayment and then they subtract that unsubstantiated "overpayment" from subsequent claims. Offsets are against the California Code of Regulations, and the Department of Labor filed an amicus brief in a lawsuit saying they agree. 

If you are a California Substance Use Treatment facility owner or CEO, please sign this letter and add your facility name in the comments section so we can get the attention and support of Sherry Rouillard at the Department of Managed Health Care.

There are also petitions to sign: Letter #1 to Attorney General Xavier Becerra and Letter #2 to INSURANCE COMMISSIONER DAVE JONES.

As many of you know, this type of letter was the beginning of how we won the fight with HealthNet.

Please sign, share, and encourage owners and Executive Directors of both non-profit and for-profit to do the same.

THE DEADLINE IS MONDAY TO SIGN IS MARCH 19. 

Sincerely,

Addiction Treatment Advocacy Coalition

Board of Directors


Petition

 

March 9, 2018

Ms. Shelley Rouillard
Director
California Department of Managed Health Care
980 9th Street, Suite 500
Sacramento, CA 95814-2725

Re: Illegal Payment Offsets by Insurers

Dear Director Rouillard:

Over the last decade, many California insurers have been illegally using cross plan offsets to penalize out-of-network providers. Cross plan offsets allow the insurer to "recoup" money they believe has overpaid to the provider from one client claim by offsetting the payment to the provider for a different client claim. For example, an insurance plan offsets an "overpayment" for an Apple employee claims against the payment due to a provider for a United Airlines employee claim.

As you know, California law states that plans and their capitated providers cannot offset "contested" overpayment recovery attempts:

28 CCR Section 1300.71
(d) Denying, Adjusting or Contesting a Claim and Reimbursement for the Overpayment of Claims:

(5) If the provider does not contest the plan's or the plan's capitated provider's notice of reimbursement of the overpayment of a claim, the provider shall reimburse the plan or the plan's capitated provider within 30 working days of the receipt by the provider of the notice of overpayment of a claim.

(6) A plan or a plan's capitated provider may only offset an uncontested notice of reimbursement of the overpayment of a claim against a provider's current claim submission when: (i) the provider fails to reimburse the plan or the plan's capitated provider within the timeframe of section (5) above and (ii) the provider has entered into a written contract specifically authorizing the plan or the plan's capitated provider to offset an uncontested notice of overpayment of a claim from the contracted provider's current claim submissions.

As you also know, the landmark class action case Peterson DC et al v. UnitedHealth Group Inc. et al, U.S. District Court U.S. District of Minnesota (DMN), Civil Docket For Case #: 0:14-cv-02101-PJS-BRT, Filed 06/23/14 reached a ruling in March of 2017. The ruling stated that cross-plan offsets were unlawful.

Subsequently, United Healthcare filed an appeal and the Department of Labor filed an amicus brief supporting the lower court decision that cross plan offsets are illegal Louis J. Peterson, D.C. v. UnitedHealth Grp., Inc., 8th Cir., No. 17-1744, amicus brief filed 9/5/17. See attachment.

While complaints have been filed with the Department of Insurance concerning cross plan offsets over the years, nothing has been done in California. The Peterson, DC case is now in mediation, which means if it is settled, the lower court decision will not set precedent and only apply to the existing case.

We implore the Department of Managed Health Care's office to act to enforce that the existing California Code of Regulations is followed by those providing insurance in California. ATAC has also alerted the Insurance Commissioner Dave Jones.

Sincerely,

The following presidents, CEOs and owners of XXX of for profit treatment facilities representing XXX of for profit treatment facilities in California:

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