ColumbiaDoctors has faced significant challenges with EmblemHealth. The ColumbiaDoctors master participation agreement covers the HIP commercial, Medicare, Medicaid, Selectcare, and the Emblem ACA lines of business. After attempting to update COLAs, and facing insurmountable difficulties in reaching agreements and negotiating with Emblem, ColumbiaDoctors leadership decided to pursue the below strategies.
A grievance letter to DFS (Department of Financial Services) went out during the week of June 8, outlining specific complaints related to outstanding accounts receivable and intractable payment and operational issues with Emblem.
The faculty practice distributed a letter to chairs in early June, recommending a strategy of “strategic disenrollment.” This strategy entails disenrolling physicians with significant wait times and who could easily fill the open slots, and implementing a 90-day hold on new enrollments, excluding facility-based providers, while ColumbiaDoctors leadership determines next steps.
If a response from DFS is received in time, it will be discussed at the Managed Care Committee meeting on July 17, if a response has been received by that date. Next steps will be discussed at that meeting and at the July 6 Steering Committee meeting.