Dealing with Insurance Company Hassles?

A handy new online toolkit -- Payment for Same-day Preventive and Acute Services -- is available to family physicians looking for solutions to combat insurance company payment denial.

"This particular payment issue is a very common complaint communicated by members," said Trevor Stone, private sector advocacy specialist in the Academy's Practice Support Division. Some insurance plans argue that payment shouldn't be expected for an overlap in services; however, "the Academy views preventive care and significant acute care services as separately reportable services -- even when given on the same day -- and (family physicians) should be paid accordingly," said Stone.

AAFP's Committee on Practice Enhancement called for the development of the toolkit, which is perhaps better defined as a compilation of resources on the topic that has been developed during the past few years.

"The Academy wants health plans to follow CPT guidelines on this issue," said Stone, and the committee "wanted to make it easy for members to access all the materials that have been developed over the past few years that support that stance."

A sample of resources found at the site include archived articles from Family Practice Management such as

Several letters regarding same-day preventive and acute care services appear in the "Tools" section in template format and are available for members to download and use. The templates provide a quick and easy way for members "to deliver a clear and concise argument to insurance payers, patients and employers," said Stone.

The toolkit's placement in the policy and advocacy area of the Academy's Web site signifies the Academy's ongoing efforts on members' behalf in the private sector advocacy arena.