Group Health Update

 

Hello, dear Friends

Here is the latest word regarding Group Health’s decision to remove  A Turning Pointe PT and Medical Lake PT  from their provider network.  First, a recap:

Several weeks ago, we were notified that effective September 4th, Group Health (GH) will remove us and several other clinics from their network.  We appealed this decision based on the clear fact that A Turning Pointe is an alternative clinic that provides service not found elsewhere in the greater Spokane area and that Medical Lake PT is the only physical therapy clinic in all of Medical Lake.  The GH decision would strip their members of their only choice for alternative care in Spokane or any kind of care in Medical Lake.  At the August 17th meeting that we had with the director of GH Provider Relations, our arguments were heard and, we think, well received.  At that point, we were told that a final decision would be forthcoming in approximately two weeks.

On August 30, we were notified that the final decision has yet to be made and that it may be another twenty days until it is made.

So, what does all this mean?

It means that as of Sunday, September 4th, until further notice, if your current authorization ends on or before September 4th, your visits past that date will not be covered.  If your authorization ends after Sep 4th, those authorizations WILL be covered.  This information came directly from Maureen Brooks, the regional Provider Relations manager.  Their decision stands until they rescind it, IF they rescind it.

We cannot guarantee that GH will make their decision in a timely matter or if it will be in our favor.  Some GH members have out-of-network benefits with their plan but that also may come with a higher out-of-pocket-expense.  We recommend that each of you consult your plan administrator or GH Customer Service to determine this.  We are happy to offer a reduced, out-of-pocket rate of $100 to or GH patient.  While we would regret the possible loss of providing service to our GH clients, we would understand if the out-of-pocket expense were prohibitive. The budget vs. health battle is a very real one and hard decisions must be made with your finances.

As soon as we get the final word from Group Health, we will be contacting all of our active patients to let them know the news.  Whether it is in our favor or not, you’ll need the information so that you can plan accordingly.  You may feel free to contact us at any time to ask us for an update on this matter.

If you wish to contact Group Health at their Spokane office to make direct inquiries, their number is 509.838.9100 or 1.800.497.221.